Gynecological tumors are common diseases that endanger women’s health. Common benign gynecological tumors include uterine fibroids, endometriosis, benign ovarian tumors, etc.; malignant tumors with higher incidence include ovarian cancer, cervical cancer, endometrial cancer and uterine sarcoma. Traditional treatment cannot improve the survival rate, but increases the incidence of complications seriously, and interventional treatment has become a new method for gynecological tumor treatment.
(i) Interventional embolization
It is applied to benign and malignant gynecologic tumors, and is performed by suspending the blood supply to the tumor, resulting in ischemic necrosis of the tumor tissue.
Advantages of gynecological tumor interventional embolization
After interventional embolization, the tissues around the tumor become soft, local infection is reduced and peripheral edema appears, which makes the tumor easy to be peeled off during surgery, reduces intraoperative bleeding, clear surgical field, and can control the spread and metastasis of cancer cells during surgery; it can also shrink the tumor lesions, reduce surgical complications, or enable patients in the middle and late stages who have lost the chance of surgery to get the chance of surgery, and create conditions for subsequent treatment. For patients with advanced malignant tumors and postoperative recurrence, interventional therapy as palliative treatment has the advantages of minimally invasive and repeatable, which can reduce patients’ pain, improve their survival quality and prolong their survival time.
Gynecologic tumor interventional embolization is applicable
It is applicable to various gynecological malignant tumors such as cervical cancer, ovarian cancer, vulvar cancer, vaginal cancer, trophoblastic tumors, endometrial cancer, etc.
(II) Interventional chemotherapy
The higher the local drug concentration of tumor, the longer the contact time between the drug and tumor cells, the better the anti-cancer effect of the drug, and the interventional intubation method is used to super-select the special catheter into the blood supply artery of tumor and infuse large doses of chemotherapeutic drugs into the tumor at one time. (ii) Interventional treatment for gynecological malignant tumors
(3) Interventional treatment for gynecological malignant tumors before surgery
The purpose is to eliminate the tiny metastases and subclinical foci around the cancer foci, so that the surgical resection can be more complete; at the same time, the drugs can be administered before the blood vessels and lymphatic vessels at all levels of the tumor are damaged, so as to increase the concentration of local chemotherapy drugs and achieve the effect of efficient killing of cancer cells; it can also reduce the size of the tumor foci, reduce the complications of surgery, or enable the patients in the middle and late stages who have lost the opportunity of surgery to obtain the opportunity of surgery, so as to create conditions for the subsequent treatment.
(4) Interventional treatment for patients with advanced malignant tumors and postoperative recurrence
For patients with liver metastasis or lung metastasis, interventional treatment as palliative treatment has the advantages of minimally invasive and reproducible, which can reduce patients’ pain, improve their survival quality and prolong survival time.
(V) Others
Radioactive particle target implantation system (particle knife), argon helium ultra-low temperature cryosurgery and ultrasound and radiological endoscopy-guided interventional techniques have also been widely used in the diagnosis and treatment of gynecologic tumors.
(VI) Interventional treatment of uterine fibroids
Uterine fibroids account for 30% to 50% of women of childbearing age in China. Clinically, most of them are diagnosed with symptoms such as abdominal mass, excessive menstruation, anemia, urinary frequency and urgency, or constipation. Traditional treatment includes total hysterectomy, myomectomy and drug therapy. However, total hysterectomy is not easy for young patients to accept, the recurrence rate of myoma removal is as high as 20%-30%, and drug treatment has more side effects and the efficacy is not ideal. In recent years, scholars at home and abroad have applied interventional radiology to the treatment of uterine fibroids with great success, and the minimally invasive uterine artery embolization (UAE) will become the treatment of choice for fibroids instead of the traditional surgical method, which can preserve the uterus with minimal trauma and significant efficacy.
Efficacy and advantages of interventional treatment of fibroids
1. Interventional treatment can avoid surgical trauma and preserve the uterus. The biggest advantage is that it can preserve uterine functions, such as normal menstruation, pregnancy and childbirth, and does not affect conception; it avoids a series of postoperative complications and is comparable to surgery in terms of symptom improvement.
2, interventional treatment does not require a longer hospital stay.
3, the cost of interventional treatment is not too high
4.Even if the interventional treatment fails, other methods can be used again. Even if embolization fails, surgery and drug treatment can still be applied.
Interventional treatment of uterine fibroids is applicable to
1.Women of childbearing age with clear diagnosis of uterine fibroids and obvious symptoms.
2.Women who want to preserve their uterus and fertility and refuse surgical treatment.
3, conservative treatment (including myomectomy and drug treatment) is ineffective or recurrence.
4.Patients whose physical condition cannot tolerate surgical treatment.
Contraindications to interventional treatment of uterine fibroids
1.Severe liver and kidney dysfunction.
2.Severe cardiovascular disease.
3.Disorders of coagulation mechanism.
4, allergic to anesthetics.
(VII) Interventional treatment of adenomyosis
Adenomyosis, also known as intrinsic endometriosis, is the invasion of the endometrium into the myometrium, and is a special type of endometriosis, which can coexist with “extrinsic” or mainly pelvic endometriosis. Treatment: Traditional Chinese medicine treatment for adenomyosis is based on blood circulation and siltation, dispersal of nodules and elimination of symptoms, together with the management of qi and stagnation, and support of the root, in order to stop bleeding, eliminate tumors and restore vitality, but clinical findings show that Chinese medicine is not suitable for the treatment of adenomyosis, because it takes a long time and the results are not ideal. Traditional surgical treatment is usually open surgery. However, it is not the best way to treat adenomyosis because it is very traumatic and because it is open, it is prone to infection. Interventional treatment is used. This treatment blocks the blood supply to the lesion and causes necrosis of the ectopic endometrium, resulting in a radical cure. Interventional treatment is minimally invasive, just like an intravenous injection, without the need to open the uterus for removal, and recovery is fast.
Efficacy and advantages of interventional treatment for adenomyosis
1, dysmenorrhea: the efficacy and effectiveness of interventional treatment in relieving dysmenorrhea in 70%-90% of patients.
2, menstruation: 89% of patients have reduced menstrual flow after interventional treatment.
3, infertility: the chance of conception in infertile patients with adenomyosis is greatly increased after interventional treatment.
4. vaginal discharge: leucorrhoea was significantly reduced after interventional treatment, and some patients were completely cured of various vaginitis due to long-term leucorrhoea and easy recurrent infection after interventional treatment.
5. uterine size: the uterus starts to soften and shrink in size 1-6 months after the intervention.
6, anemia: patients with significantly reduced menstrual flow after interventional treatment patients generally return to normal or near normal hemoglobin levels 3 months after interventional surgery.
Indications for interventional treatment of adenomyosis
1, patients with typical clinical symptoms and signs and clear clinical diagnosis such as ultrasound and MRI.
2, women of all ages, patients with many surgical concerns or those with fertility requirements who do not want to remove the uterus
3, patients with a history of pelvic surgery, or pelvic adhesions and estimated surgical difficulties
4.Patients suffering from heart and lung diseases, hyperthyroidism, diabetes, psychosis and other diseases that are not suitable for open surgery, and those with serious clinical symptoms such as dysmenorrhea and excessive menstruation, which affect their health.
5, those who are ineffective in drug treatment or have large side effects and cannot continue drug treatment
6, combined with uterine fibroids.
Contraindications for interventional treatment of adenomyosis
1, acute inflammatory period or acute attack of chronic inflammation.
2.History of allergy to various contrast agents.
3.Severe cardiopulmonary, hepatic and renal diseases, hyperthyroidism, diabetes mellitus. Patients with uncontrolled disease, unstable vital signs and unable to move.
4.Patients who are pregnant or suspected to be pregnant.
5.Patients with untreated pelvic inflammatory disease or vaginitis.
6.Cancerous cells or suspected cancer cells found by endometrial diagnostic scraping pathological examination, atypical hyperplasia of the endometrium.
7.Persons with rapid growth of the uterus in a short period of time and suspected uterine sarcoma
8, severe coagulation dysfunction.
(H) Interventional treatment of uterine arteriovenous malformation
Arteriovenous malformation (AVM) was once called arteriovenous fistula, varicose vein aneurysm, cavernous hemangioma, etc. It can occur in all organs of the body, but in gynecology, it mainly occurs in uterine and parametrial arteriovenous malformation, which is one of the rare but serious causes of vaginal hemorrhage, and patients who lose a lot of blood in a short period of time can suffer from Traditionally, the treatment of massive vaginal bleeding has been done by scraping, even at the cost of hysterectomy. With the development of interventional technology, uterine artery embolization is a treatment method that can effectively stop bleeding while preserving the uterus. Arterial embolization is widely used in clinical practice because of its less invasive and faster onset of action. Arteriography is the “gold standard” for the diagnosis of parametrial and uterine arteriovenous malformations, as it can determine the size of the lesion, the supplying arteries, the draining veins, and the relationship with the normal pelvic vessels.
Efficacy and advantages of interventional treatment for uterine arteriovenous malformations
With the development of interventional technology, uterine artery embolization is a treatment method that can effectively stop bleeding while preserving the uterus, with less trauma and faster onset of action. It is the “gold standard” for the diagnosis of uterine arteriovenous malformations.
Indications for interventional treatment of uterine arteriovenous malformation
1.Stopping bleeding. Mainly used for tumor rupture and bleeding, postpartum bleeding, uterine bleeding caused by ectopic pregnancy, vascular malformation, arteriovenous fistula and symptomatic uterine fibroids, etc.
2.Arterial perfusion. Chemotherapy (chemotherapy).
3.Localization and diagnosis. Selective or superselective arteriography of the lesion or bleeding site to determine the lesion site and clarify the diagnosis.