Do we have to "dig and dig"?, [Bodyguard] Got uterine fibroids and mucous membranes | Surgery | Uterine fibroids

Clinically, it has been found that many girls suffer from uterine fibroids. Do uterine fibroids need to be "dug and dug"? Which uterine fibroids require surgical treatment and which can be followed up regularly? We have listed relevant knowledge for female friends to refer to regarding this common disease.

First, let's get to know uterine fibroids. Uterine fibroids are the most common benign tumor in women, which can cause symptoms such as excessive menstrual flow, irregular vaginal bleeding, frequent urination, and even infertility. The symptoms are closely related to the location and growth rate of the fibroids. If there are no clinical symptoms causing discomfort in uterine fibroids, and there is no suspicion of malignancy, especially in women approaching menopause, regular outpatient follow-up can be performed without the need for special treatment. Follow up is usually conducted every 3-6 months. Most postmenopausal uterine fibroids can stop growing or atrophy.

If you have the following symptoms, it is recommended to undergo surgical treatment:

Uterine fibroids combined with excessive menstruation or abnormal bleeding, even leading to anemia;

Uterine fibroids compress the bladder, rectum, nervous system, and other related symptoms, which are ineffective after drug treatment;

Uterine fibroids combined with infertility;

For patients with uterine fibroids who are preparing for pregnancy, if the diameter of the fibroid is ≥ 4 cm, it is recommended to remove it;

Individuals who have not undergone hormone replacement therapy after menopause but still have fibroids growing.

For patients with uterine fibroids, surgery is a common treatment method. However, the choice of surgical method is a complex issue that requires careful consideration. How should female friends make choices when facing different surgical methods?

Before understanding the types of fibroids, we need to know that the outer side of the uterine muscle layer is called the serosal surface, the uterine cavity surface is called the mucosal surface, and between the two is the uterine muscle layer.

According to the relationship between fibroids and the uterine wall, they can be divided into four types: subserosal fibroids, intramural fibroids, submucosal fibroids, and broad ligament fibroids.

According to the growth site, it can be divided into 9 types:

Type 0: Submucosal fibroids completely located in the uterine cavity;

Type I: Most of the fibroids are located in the uterine cavity, and the part of the fibroids located between the muscle walls is less than or equal to 50%;

Type II: Fibroids with intramural protrusions to the submucosal layer, with a portion of the fibroid located between the muscle walls exceeding 50%;

Type III: The fibroid is completely located between the muscle walls, but its location is close to the mucosa;

Type IV: The fibroid is completely located between the muscle walls, neither near the serosal layer nor towards the mucosal layer

Type V: The fibroid protrudes towards the serosa, but is located between the muscle walls and is greater than or equal to 50%;

Type VI: The fibroid protrudes towards the serosa, but is less than 50% located between the muscle walls;

Type VII: Pedicle subserosal fibroid;

Type VIII: Other types, such as fibroids in special areas such as the cervix, uterine horn, and broad ligament.

From this, it can be seen that regardless of the classification, the location of the fibroid is crucial. Because fibroids in different parts have different clinical symptoms, which determine whether surgical intervention is needed; The choice of surgical method also needs to be determined based on the location, quantity and size of the fibroids, suspicion of malignancy, and patient needs.

The clinical symptoms caused by symptomatic uterine fibroids can be better understood by referring to the 9-type classification method.

1. Menstrual changes are common in type 0-type II, manifested as a significant increase in menstrual volume with blood clots, prolonged menstruation, dripping bleeding and shortened menstrual cycle, so secondary anemia often occurs, and patients feel dizzy and weak. Increased vaginal discharge and vaginal discharge may also occur. Submucous myomas can also cause dysmenorrhea. Sometimes type 0 pedicled submucosal uterine fibroids, pedicle extension may even prolapse from the cervical opening to the vagina.

At this time, hysteroscopic surgery can be considered for type 0-type I submucosal uterine fibroids with a diameter of ≤ 5cm. If the leiomyoma is small and the operation goes smoothly, you can be discharged after observation in the hospital for a short time after the operation. For type II myoma, hysteroscopy can only be protruding in the uterine cavity of the myoma to do partial resection, can not be a complete resection of the myoma, it does not recommend hysteroscopy.

2. Type V-VIII uterine fibroids, when the fibroids are large, may palpate abdominal mass, which is more obvious when the bladder is full in the morning. It may also oppress the bladder and rectum with corresponding oppression symptoms, such as frequent urination and constipation. Distortion of the pedicle of the subserosal myoma may present with acute abdominal pain. No matter what kind of uterine fibroids if the impact of uterine cavity morphology, obstruction of the fallopian tube opening or oppression of the fallopian tube to distort and deformation may lead to infertility.

3. Type III-VIII uterine fibroids, if they cause compression symptoms or have other surgical indications, the surgical treatment plan usually chooses laparoscopy or laparotomy. Experienced doctors will decide the operation method according to the patient's age, whether there are fertility requirements, the number of uterine fibroids and the growth site of uterine fibroids. That is, patients are usually most concerned about: can they keep the uterus? If they keep the uterus for laparotomy or laparoscopic surgery?

-For young patients with a large number of fibroids who want to retain the uterus, open surgery is recommended, because laparoscopic surgery can easily lead to residual fibroids.

For perimenopausal patients with a high number of fibroids, laparoscopic total hysterectomy may be considered. Due to the large trauma, excessive intraoperative bleeding, and slow recovery of open myomectomy, laparoscopic total hysterectomy has less trauma, less intraoperative bleeding, and faster recovery.

For young patients with larger fibroids who require the preservation of the uterus, it is recommended to choose open surgery, as the fibroids are larger and the laparoscopic operating space is limited, making the surgery more difficult.

For patients with significantly enlarged postmenopausal fibroids or ultrasound indicating fibroid degeneration, it is recommended to remove the uterus, as there is a risk of malignant transformation of the fibroids. Retaining the uterus increases the risk of malignant tumor dissemination and secondary surgery.

Due to different surgical methods and approaches, contraindications also vary. But if there are the following situations, immediate surgery is not recommended: acute stage of reproductive tract or systemic infection; Acute phase of severe internal medicine diseases such as heart, liver, and kidney failure; Severe coagulation dysfunction and blood diseases; There are other situations where anesthesia and surgery cannot be tolerated; Laparoscopy is prohibited for patients with diaphragmatic hernia; Uterine fibroids that grow rapidly and have imaging indications of malignancy are not suitable for uterine fibroid removal surgery.

It is also important to prevent the occurrence of uterine fibroids after surgery. At present, the etiology of uterine fibroids is not yet clear. The possible pathogenesis is related to genetic susceptibility, sex hormone levels, and stem cell dysfunction. The main high-risk factors include age over 40 years old, young age at menarche, infertility, late childbirth, obesity, polycystic ovary syndrome, hormone supplementation therapy, and a family history of uterine fibroids.

Therefore, postoperative prevention mainly includes the use of steroid drugs, maintaining healthy eating habits and a good lifestyle, exercising appropriately and controlling weight, and regularly undergoing gynecological examinations to detect and treat early. Finally, maintaining a positive mindset, reducing stress and anxiety, can also help prevent the occurrence of uterine fibroids.

In addition, in addition to surgery, there are other treatment options for uterine fibroids, such as drug therapy, uterine artery embolization, and high-energy ultrasound focused ablation. Various treatment plans have their corresponding indications, contraindications, advantages and disadvantages. Doctors need to develop personalized treatment plans based on the patient's age, fertility needs, number and location characteristics of uterine fibroids.