According to a survey by the World Health Organization (WHO), over 96% of married women in China suffer from varying degrees of gynecological diseases, one of which is very common, uterine fibroids.
Uterine fibroids, as the name suggests, are tumors that grow in the uterus and are more common in women between the ages of 30 and 50. When uterine fibroids are small in size, they generally do not cause any abnormalities, and many female friends only discover them during ultrasound examinations.
The harm of uterine fibroids
1. For women of childbearing age, the biggest harm of uterine fibroids is the impact on pregnancy, because if the location of uterine fibroids is near the fallopian tubes, it may compress them, hinder normal ovulation and fertilized egg implantation, and lead to long-term inability to conceive. Even if successful conception is achieved, the probability of miscarriage for patients will be significantly higher.
2. Long term excessive menstrual flow caused by uterine fibroids can lead to blood deficiency in patients, causing a decline in physical fitness, and can also cause other gynecological diseases such as pelvic inflammatory disease, pelvic inflammatory disease, endometritis, etc.
3. The most worrying thing is probably that uterine fibroids can become cancerous. Although this probability is very small, it does not mean that it will not happen at all. As age increases, the probability of benign tumors turning into malignant tumors will also increase.
At present, there are several surgical methods for uterine fibroids:
1. Abdominal surgery
Abdominal myomectomy is suitable for those who have fertility requirements and hope to preserve the uterus. The specific choice of laparoscopic or open surgery depends on the surgeon's surgical technique and experience, as well as the patient's own conditions. Patients who do not have fertility requirements and do not wish to preserve their uterus may undergo total hysterectomy. For young individuals who wish to preserve their cervix, subtotal hysterectomy is also feasible. Preoperative screening for cervical cancer should be monitored to reduce the incidence of cervical stump cancer.
For those with a large number of fibroids, fibroids with a diameter greater than 10cm, fibroids in special areas, and severe pelvic adhesions that increase the difficulty of surgery or may increase the risk of uterine rupture during future pregnancies, open surgery is recommended.
It should be emphasized that laparoscopic removal of uterine fibroids must be carried out in a closed crushing bag; Some experts also suggest placing it in a bag and removing it through a single incision or vaginal posterior fornix incision to ensure tumor free operation during surgery.
2. Hysteroscopy surgery
Suitable for type 0 submucosal fibroids; Type I and II submucosal fibroids, with a diameter of ≤ 5.0cm; intramural protrusion fibroids, with a muscle layer covering the surface of the fibroid ≤ 0.5cm; various types of submucosal fibroids of the uterus or cervix that detach into the vagina; The length of the uterine cavity is ≤ 12cm; the volume of the uterus is less than the size of 8-10 weeks of pregnancy, excluding patients with malignant transformation of the endometrium and fibroids.
In addition to general contraindications, cervical scars causing the cervix to become hard and unable to fully dilate are contraindications for hysteroscopic surgery.
3. Transvaginal surgery can be considered for those without indications for open abdominal exploration. Uterine fibroid removal surgery should be performed on married patients with good uterine activity, with ≤ 2 fibroids and a diameter of ≤ 6cm, located in the cervix, cervical isthmus, lower segment of the uterus, and anterior and posterior walls of the uterus. Fully understand the patient's condition before surgery, strictly select indications, and prepare for conversion to open surgery.
Surgical contraindications: ① Vaginitis, vaginal stenosis, and vaginal malformation that cannot expose the surgical field; ② Severe pelvic adhesions, limited uterine mobility, and the possibility of damaging pelvic organs; ③ History of 2 or more gynecological abdominal surgeries, especially if a history of cesarean section of the uterine body cannot be ruled out, which increases the difficulty of surgery and may lead to conversion to open surgery; ④ Elderly individuals who cannot tolerate surgery or cannot obtain a bladder lithotomy site; ⑤ Patients with pelvic malignant tumors and indications for open abdominal exploration.
Due to the full utilization of the natural channel of the female body - the vagina - during vaginal surgery, there is less interference with abdominal organs and less postoperative pain. After mastering the techniques of vaginal surgery, the surgeon can perform the surgery.
4. Other minimally invasive surgeries or local treatments for uterine fibroids include: transcatheter uterine artery embolization, high-intensity ultrasound focused ablation, radiofrequency ablation, microwave ablation, cryotherapy, uterine heat bulb therapy, etc.
Compared with traditional myomectomy and hysterectomy, most of these methods relieve uterine fibroid symptoms by reducing the volume of the fibroid or destroying the endometrium. It is not easy to obtain fibroid tissue for pathological examination, but most of them are more minimally invasive or even non-invasive, and their treatment methods have their own advantages and limitations.