For the treatment of uterine fibroids, if you still only stay in observation, medicine, picking tumor, cutting uterus, it is too OUT, today I will share with you from ancient times to the present about the first gynecological tumor – uterine fibroids 15 kinds of treatment methods.
1.Observation therapy
The progress of uterine fibroids is observed by regular follow-up, usually once every 3-6 months. The follow-up includes changes in clinical symptoms, changes in the size, number and location of fibroids under gynecological examination; changes in the size and nature of fibroids under ultrasound.
Indications: myoma diameter <5cm, solitary or subplasma growth; uterus size not larger than 10 weeks of pregnancy; no changes such as increased menstrual flow and dribbling; no pressure symptoms such as urinary frequency, urinary urgency and long-term constipation; myoma is not the main cause of infertility or miscarriage; no complications such as secondary anemia; no tendency to degeneration; near-menopausal women.
2.Drug therapy
As a hormone-dependent tumor, the main therapeutic drugs for uterine fibroids include various anti-sting hormone agents to shrink the tumor or inhibit its growth. The commonly used drugs include gonadotropin-releasing hormone agonists (GnRHa), mifepristone, oral contraceptives, progestins, etc. The common routes and methods of administration include the following The common routes and modes of administration include subcutaneous injection or oral administration, local vaginal administration, intrauterine device with medication (levonorgestrel intrauterine release system), and interventional suppository administration.
Indications: young people with fertility requirements, temporary shrinkage of fibroids after drug treatment to increase the chances of conception; perimenopausal women with fibroids <5cm and mild symptoms; preoperative adjuvant medication to reduce the size of the tumor and facilitate surgical operation; indication for surgery, but combined with medical and surgical diseases that cannot tolerate surgery.
Contraindications: obvious symptoms of submucosal myoma, leading to anemia and affecting pregnancy; torsion of subplasma myoma; myoma causing obvious pressure symptoms; fast growth of myoma, ultrasound suggests degeneration and cannot exclude malignant change.
3.Transabdominal myomectomy
Indications: young women under 40 years old who want to retain their fertility, or those who do not have fertility requirements but want to retain the uterus; large fibroids; excessive menstruation and ineffective drug treatment; subplasma fibroids; single or multiple interstitial fibroids; interstitial fibroids that are too large and protrude into the uterine cavity, making laparoscopic surgery difficult; cervical fibroids, isthmus fibroids or broad ligament fibroids.
Contraindications: combined with pelvic infection or suspected malignant change.
5.Transabdominal hysterectomy
Commonly used procedures include total hysterectomy, subtotal hysterectomy and intrafascial hysterectomy.
Indications: women who are menstruating, no childbearing requirement; multiple fibroids, uterus more than 3 months gestation size; obvious symptoms; failure of conservative treatment; recurrence of fibroids after resection; fast growth rate of fibroids and suspicion of malignant change.
Contraindications: the same as other surgical contraindications.
5.Transvaginal hysterectomy
It has many advantages such as less pelvic interference, less postoperative pain, faster recovery, less complications, and maximum preservation of the integrity of the vaginal vault.
Indications: cervical fibroids or fibroids smaller than 12 weeks of gestation; combined with cervical precancerous lesions; combined with moderate to severe uterine prolapse requiring hysterectomy.
Contraindications: those who suffer from systemic diseases of important organs and cannot tolerate surgery; uterus over 12 weeks of gestation; severe endometriosis, pelvic inflammatory disease or history of lower abdominal surgery leading to severe pelvic adhesions; fibroids with suspected malignant transformation; narrow pubic arch or vaginal stenosis; large adnexal cysts.
6.Yin type myomectomy
Indications: Uterine mobility, size less than 12 weeks of pregnancy; ultrasound and gynecological examination suggesting subplasma myoma and/or interstitial myoma; those who require preservation of the uterus.
Contraindications: poor uterine mobility, obvious pelvic adhesions; maximum fibroid diameter greater than 12 cm; uterine volume more than 12 weeks of gestation.
7.Hysteroscopic myomectomy
Hysteroscopic myomectomy is preferred for any submucosal, intermural and cervical fibroids that affect the normal shape of the uterine cavity or cervical canal and are associated with symptoms of excessive menstruation or abnormal uterine bleeding.
Indications: submucosal fibroids with tissues, which are completely located in the uterine cavity without extension of the tissues into the muscular layer; submucosal fibroids without tissues, which are ≤5.0 cm in diameter; intramural intermural fibroids, which are ≤5.0 mm in surface coverage of the muscular layer; all types of submucosal fibroids of the uterus or cervix that have prolapsed into the vagina; uterine cavity length ≤12 cm; uterine volume less than 10 weeks of gestation; exclusion of endometrium and fibroid malignancy.
Contraindications: those suffering from systemic important organ diseases that cannot tolerate surgery; severe cervical scarring that cannot be adequately expanded; acute stage of reproductive tract infection.
8.Laparoscopic myomectomy
Indications: obvious symptoms caused by fibroids; single fibroids <10cm in diameter, multiple fibroids up to 4 in number; subplasmalembranous or convex interstitial fibroids; the possibility of malignant fibroids has been ruled out before surgery;
Contraindications: malignancy cannot be ruled out; pregnant uterus; submucosal myoma or intramural myoma.
9.Laparoscopic hysterectomy
Indications: menstruating women, no requirement for childbirth; multiple uterine fibroids, uterus over 3 months gestation size; obvious symptoms; failure of conservative treatment; recurrence of fibroids after resection.
Contraindications: difficult to tolerate anesthesia; severe bleeding disorders or coagulation dysfunction; acute peritonitis with severe epigastric distention; previous pelvic and abdominal tuberculosis or severe inflammation resulting in severe pelvic and abdominal adhesions that prevent the establishment of a pneumoperitoneum.
10.Arterial embolization
Embolization is performed by inserting a catheter into the uterine artery or the anterior trunk of the internal iliac artery or the ovarian artery through percutaneous puncture of the catheter, thereby cutting off the blood supply to the myoma and causing it to atrophy and fall off.
Indications: Those who have failed conservative treatment; those with obvious symptoms; those who refuse surgery and require preservation of myometrial reproductive function; those with asymptomatic fibroids >4cm in diameter; those who cannot tolerate surgery due to severe combined medical diseases; those with giant fibroids who require preoperative embolization to reduce intraoperative bleeding.
Contraindications: pregnant women; myoma malignancy cannot be excluded; subplasmalignant myoma with thin tissues or broad ligament myoma and free myoma; uterine arteriovenous fistula; allergy to contrast media; severe coagulation mechanism abnormalities; acute stage of reproductive tract infection; infection at the puncture site; serious dysfunction of important organs such as heart, liver and kidney.
11.Radiofrequency ablation
High-frequency alternating current is introduced into the tissue through electrodes, and then the circuit is formed by diffusion electrodes. The ions in the tissue around the electrodes are shocked by the current, generating frictional heat, which can make the local temperature reach 100℃, further causing the myoma tissue or cells to be directly coagulated by heat, degeneration and death, damage to the blood vessel wall around the myoma, thrombosis and termination of blood supply, causing ischemic degeneration and necrosis of the lesion tissue, and also causing the tumor surrounding It can also denature and inactivate estrogen and progesterone receptors around the tumor and prevent its growth.
Indications: submucosal leiomyosarcoma of any size; intermural leiomyosarcoma between 2 and 5 cm in diameter; cervical submucosal visualizable leiomyosarcoma; cervical intermural leiomyosarcoma (≤4 cm in diameter); intermural partial subplasmic leiomyosarcoma (≤5 cm in diameter) with an ectopic portion ≤2 cm.
Contraindications: subplasma myoma or intermural ectopic myoma in which the main part of the myoma is outside the uterine contour; myoma in the isthmus, lateral wall and uterine horn; menstruation, pregnancy and lactation; acute inflammation or malignant tumor of the reproductive system; combination of other serious medical diseases; infertile; other minimally invasive interventions within 3 months.
12.Microwave ablation
The thermal effect of microwaves on the human body can cause the local temperature of the tissue to reach 60-100℃, followed by coagulation, degeneration, necrosis, and finally absorption or discharge of degenerated tissue; the non-thermal effect of microwaves can accelerate the absorption of necrotic tissue and wound healing, and improve the cellular and humoral immune function.
Indications: Tender submucosal leiomyosarcoma; 3-6 cm in diameter, non-tender submucosal leiomyosarcoma or interstitial leiomyosarcoma; less than 3 leiomyosarcomas.
Contraindications: submucosal leiomyosarcoma with tissues; leiomyosarcoma adjacent to important organs such as intestine, bladder and large blood vessels that are difficult to distinguish; menstruation, pregnancy, lactation; acute inflammation or malignant tumor of the reproductive system; combined with other serious medical diseases; those who have not given birth; those who have received other minimally invasive interventions within 3 months.
13.Cold and heat ablation treatment
The main principle is to use argon helium knife to combine ultra-low temperature freezing and interventional thermal therapy, using argon gas in the tip of the knife rapid cooling effect, within a few seconds to reduce the tissue temperature to below -100 ℃, forming ice crystals in the tissue cells, and then using helium gas in the tip of the knife rapid heating effect, rapid thawing of the ice ball and rapid warming to 50 ℃, so that the intracellular ice crystals burst, resulting in the complete destruction of cells, myoma vascular bed vascular Embolism occlusion and nerve destruction within the tumor.
Indications: solitary submucosal and intermucosal leiomyosarcoma with a diameter of 2 cm or more; multiple leiomyosarcomas with no more than 4; all types of cervical leiomyosarcoma.
Contraindications: subplasmalemmal fibroids with tissues; menstruation, pregnancy, lactation; acute inflammation or malignant tumor of the reproductive system; combined with other important system of serious medical diseases.
14.Uterine heat ball treatment
The main principle is to make the endometrium damaged by heat, so as to reduce uterine bleeding.
Indications: Premenopausal women without fertility requirements, excessive uterine bleeding due to benign diseases; symptomatic treatment of excessive menstrual flow and irregular bleeding due to non-submucosal myoma with insignificant cavity enlargement and still normal morphology.
Contraindications: allergy to rubber; endometrial precancerous lesions and endometrial cancer; uterine malformation; history of previous cesarean section; uterine cavity depth >10cm, volume >30cm and depth <6cm, volume <2cm; acute inflammation or malignant tumor of reproductive system.
15.Magnetic resonance guided focused ultrasound (MR-HIFU)
Also known as “magnetic wave therapy”. MRI is used to precisely locate the target area of uterine fibroids and monitor the relative change of temperature in real time by using the color temperature map generated on the image, and then combined with high-frequency focused ultrasound (HIFU), the ultrasound beam can be focused on the target point after passing through soft tissues, so that the temperature of the focused target area can instantly generate high temperature of 65℃ or more to cause coagulation and necrosis of tumor tissue, and further necrosis and detachment of fibroids. Under the monitoring of MRI, the amount, time and location of ultrasound beam can be controlled more precisely.
Indications: Patients with symptomatic fibroids of childbearing age who have completed childbirth; patients who can clearly express their feelings during treatment and communicate with the physician; uterine volume <16 gestational weeks; fibroids 2.5-10.0 cm in diameter and <10 in number.
Contraindications: contraindications to MRI; pregnancy; severe scarring in the lower abdomen; fibroids <3 cm in diameter; more than 2 fibroids with a single fibroid volume <3 cm; fibroids in a posterior position, near the sacrum; combined adenomyosis; BMI >30 kg/m2, unable to tolerate prone position for 4 h; known or suspected pelvic malignancy or precancerous lesions; claustrophobic patients; Uterine fibroids with predominantly high signal mixed signal on T2WI; intestinal canal in the focused ultrasound field and unavoidable.