Surgical Treatment Strategies of Intravenous Leiomyomatosis withRight Cardiac Cavities Extension.
Objective To investigate the diagnosis and surgical treatment strategies of intravenous leiomyomatosis(IVL)extending through inferior vena cava into the right cardiac cavities. Methods Thirty patients of IVL extending through inferior vena cava into the right cardiac cavities were treated in Peking Union Medical College Hospital from November 2002 to January 2015.The following variables were studied: age,cardiopulmonary bypass time,deep hypothermic circulatory arrest time,origins of IVL,blood loss,duration of post-operative hospital stay,hospitalization expenses,edema of lower extremity,blood transfusion,postoperative complication,residual IVL,and re-grow or recurrence. Results Thirteen of 30 patients reported double lower limb edema. The cardiopulmonary bypass was applied in 27 cases,and the average duration of cardiopulmonary bypass was(106.9±53.7)min. Then,21 patients were treated with the deep hypothermic circulatory arrest,and the mean time was(28.2±11.6) min. The tumors originated from the genital veins in 9 cases,the iliac vein in 13 cases,and both veins in 8 cases. The average intra-operative blood loss volume was (2060.5±2012.3)ml,and 21 patients received blood transfusion. The average hospitalization time was(18.9±8.3)days and the average hospitalization expenses was (80 840.4±28 264.2)RMB yuan. While 14 patients had postoperative complications,there was no serious postoperative complication or death.All patients have shown a favorable outcome.Conclusions Tumor embolus extending through inferior vena cava into the right cardiac cavities should be suspected in patients with multiple hysteromyoma. Successful therapy for IVL with right cardiac cavities extension is dependent on reasonable surgical treatment strategies. Surgical removal of the ovaries is vital to avoid IVL re-grow or recurrence.
Department of Cardiac Surgery,PUMC Hospital,CAMS and PUMC,Beijing 100730,China.
Guo-Tao
GT
Ma
Department of Cardiac Surgery,PUMC Hospital,CAMS and PUMC,Beijing 100730,China.
Qi
Q
Miao
Department of Cardiac Surgery,PUMC Hospital,CAMS and PUMC,Beijing 100730,China.
Xing-Rong
XR
Liu
Department of Cardiac Surgery,PUMC Hospital,CAMS and PUMC,Beijing 100730,China.
Chao-Ji
CJ
Zhang
Department of Vascular Surgery,PUMC Hospital,CAMS and PUMC,Beijing 100730,China.
Yue-Hong
YH
Zheng
Department of Vascular Surgery,PUMC Hospital,CAMS and PUMC,Beijing 100730,China.
Jiang
J
Shao
Department of Obstetrics and Gynecology,PUMC Hospital,CAMS and PUMC,Beijing 100730,China.
Ning-Hai
NH
Cheng
Department of Hepatic Surgery,PUMC Hospital,CAMS and PUMC,Beijing 100730,China.
Shun-da
SD
DU
Department of Cardiac Surgery,PUMC Hospital,CAMS and PUMC,Beijing 100730,China.
Jian-Zhou
JZ
Liu
Department of Surgery,PUMC Hospital,CAMS and PUMC,Beijing 100730,China.
Chao
C
Jiang
D002315:Cardiopulmonary Bypass; D050792:Circulatory Arrest, Deep Hypothermia Induced; D005260:Female; D006338:Heart Neoplasms / Q000601:surgery*; D006801:Humans; D018231:Leiomyomatosis / Q000601:surgery*; D007902:Length of Stay; D009364:Neoplasm Recurrence, Local; D010053:Ovary; D011183:Postoperative Complications; D019043:Vascular Neoplasms / Q000601:surgery*; D014680:Veins / Q000473:pathology; D014682:Vena Cava, Inferior / Q000473:pathology