Three principles for treating uterine fibroids

　　Uterine fibroids It’s a common type among women Gynecology disease . If you want to stay away from uterine fibroids, you must find the right method. Here are several treatment methods recommended.

　　Uterine fibroids vary greatly in tumor size, ranging from the smallest microscopic fibroid to the size of a full-term pregnancy. Their symptoms are also variable, and the tumor growth location varies depending on whether you are pregnant or not, so there are many treatment methods, including expectant therapy, drug therapy, and surgical treatment (including conservative surgery and radical surgery, and the surgical approaches and methods are also individualized for each person). This shows that not all fibroids require surgical treatment.

　　1. Expectant treatment　　Expectant therapy has its unique advantages and is increasingly accepted by people. Expectant therapy is mainly suitable for those with uterus less than 12 weeks gestation size and asymptomatic, especially those who are close to 12 weeks gestation. menopause For women in the first trimester, review every 3-6 months. During the follow-up period, pay attention to whether the uterus is enlarged and whether symptoms appear. If necessary, review the B-ultrasound. Otherwise, surgical treatment can be used at any time. According to reports in the literature, as long as there is sufficient high-resolution ultrasound or MRI for follow-up, expectant therapy can be chosen even for fibroids > 12 weeks of gestation.

　　2. Drug treatment

　　Drug therapy is an important measure in the treatment of fibroids. Those who may consider drug therapy are:

　　1. Uterine fibroids are less than 2-2.5 months pregnant uterus, the symptoms are mild, and the age is near menopause; 2. The fibroids are large and it is necessary to preserve the reproductive function and avoid excessive uterus and too many incisions; 3. The fibroids are caused by Menorrhagia、anemia Women who are 45-50 years old and who may consider surgery, but are unwilling to undergo surgery; 4. Those with larger fibroids who are ready for vaginal, laparoscopic, or hysteroscopic surgical resection; 5. Those with uterine resection to correct anemia and avoid intraoperative blood transfusions and resulting complications; 6. Those with fibroids combined with infertility take medication to shrink the fibroids and create conditions for conception; 7. Those with medical complications who cannot undergo surgery. Contraindications are: 1. The fibroids grow rapidly and malignant transformation cannot be ruled out; 2. The fibroids degenerate and malignant transformation cannot be ruled out; 3. The symptoms of submucosal fibroids are obvious and affect pregnancy; 4. The subserosal fibroids are torsed; 5. The fibroids cause obvious compression symptoms, or the fibroids become pelvic incarcerated and cannot be reset.

　　3. Surgical treatment

　　Surgery remains the main treatment for fibroids.

　　1. Abdominal hysterectomy: It is suitable for patients who have no desire to have children, whose uterus is ≥12 weeks of gestation; menorrhagia accompanied by blood loss anemia; fibroids growing rapidly; symptoms of bladder or rectal compression; conservative treatment failure or recurrence after fibroid enucleation, and the tumor is large or the symptoms are severe.

　　2. Vaginal hysterectomy: Suitable for those who have no adhesion or inflammation in the pelvis and no lumps in the appendages; those who have no scars on the abdomen or those with abdominal obesity; the volume of the uterus and fibroids does not exceed the size of a 3-month pregnancy; those with uterine prolapse can also undergo vaginal resection of the uterus and pelvic floor reconstruction at the same time; those who have no previous pelvic surgery history and do not need to explore or remove the appendages; those whose fibroids are accompanied by diabetes, hypertension, coronary heart disease , obesity and other medical comorbidities who cannot tolerate laparotomy.

　　3. Cervical myomectomy: If the cervix and vaginal fibroids are too large and cause surgical difficulty, surgery should be performed as soon as possible (transvaginally); large fibroids will cause compression symptoms and compress the rectum, ureter or bladder; fibroids grow rapidly and are suspected of malignant transformation; young patients who need to preserve their fertility can undergo fibroid resection, otherwise total hysterectomy is performed.

　　4. Broad ligament myomectomy: suitable for patients with large tumors or symptoms of compression; patients with difficulty in distinguishing broad ligament fibroids from solid ovarian tumors; fibroids growing rapidly, especially those with suspected malignant transformation.

　　5. Submucosal fibroids often lead to excessive menstrual flow and prolonged menstruation require surgical treatment. Depending on the location of the fibroid or the thickness of the tumor pedicle, the clamp method, the loop method, the capsular incision method, the electric incision, the torsion removal method, etc. can be used. Hysteroscopic surgery can also be performed, up to open, vaginal or laparoscopic hysterectomy.

　　6. Laparoscopic or laparoscopic-assisted uterine fibroid surgery: Myomectomy is mainly suitable for symptomatic fibroids, single or multiple subserosal fibroids with a maximum diameter of ≤10cm, and pedunculated fibroids are most suitable; single or multiple intramural fibroids, with a minimum diameter of ≥4cm and a maximum of ≤10cm; multiple fibroids ≤10; the possibility of malignant transformation of the fibroids has been excluded before surgery. Laparoscopically assisted myomectomy can appropriately relax the surgical indications. Laparoscopic or laparoscopic-assisted hysterectomy is mainly suitable for patients with large fibroids, obvious symptoms, ineffective drug treatment, and no need to preserve fertility. However, it is not suitable for patients with large tumors, severe pelvic adhesions, suspected malignant tumors of the reproductive tract and general contraindications for laparoscopic surgery.

　　7. Hysteroscopic surgery: For symptomatic submucosal fibroids and intramural fibroids protruding into the uterine cavity, hysteroscopic surgery is first considered. Mainly suitable for menorrhagia, abnormal uterine bleeding, submucosal fibroids or intramural tumors protruding into the uterine cavity, with a diameter of <5cm.

　　8. Other minimally invasive surgeries for uterine fibroids, including microwave, cryotherapy, and bipolar vaporization, are only suitable for smaller submucosal fibroids; radiofrequency treatment and focused ultrasound also have their own unique scope of adaptation, and not all fibroids can be treated. Uterine artery embolization also has its scope. In short, various treatments have their own pros and cons, and have their own indications. Each method cannot completely replace another method, let alone traditional surgical treatment, and should be selected on an individual basis. The effects, side effects and complications still need to be further observed, and no premature or absolute conclusions can be made.