What is the interventional treatment for uterine fibroids?

  Uterine fibroids are common benign tumors in women of reproductive age, with a peak age of 41-50 years old, accounting for 54.9%. According to some statistics, the incidence rate of women over 30 years old is up to 20-30% or more, accounting for about 51.78% of benign tumors in women. The common symptoms are frequent and excessive menstruation and prolonged menstruation, which make the patient anemic and physically weak, especially for submucosal leiomyoma, the bleeding rate is almost 100%, and 74% and 36% for intermural and subplasma respectively. Traditional treatment methods include surgery and medication, and in recent years, vascular interventions have been used to achieve better results.  The mechanism of interventional treatment for uterine fibroids: essentially, devascularization of uterine fibroids is an important part of interventional treatment for uterine fibroids, and this selective devascularization is related to the blood supply characteristics of fibroids.  The normal uterus is mainly supplied by bilateral uterine arteries, and each uterine artery branches and anastomoses with each other in turn, forming a rich network of traffic vessels. In addition to the bilateral uterine arteries as the main source of blood supply, the uterus itself receives blood from several vessels, and theoretically there are six other arteries with which it forms a rich collateral circulation with a strong vascular network reserve function. In the presence of a normal blood supply from the uterine artery, the network of vessels in the middle of the uterine body does not open or is only partially open. After embolization of uterine artery, because the diameter of embolic agent particles is about 300-500μm, theoretically the embolic agent will not enter its functional vessels – distal radial vessels and spiral arteries, which ensures the unobstructed traffic vessel network in the myometrium and receives blood flow from other arteries to provide blood supply to the uterus, although the blood flow is not large, it is sufficient to Although the blood flow is not large, it is sufficient to maintain the normal nutrition of the uterus and will not cause extensive necrosis of the uterus.  Fibroids are neoplastic tumors that rely on bilateral uterine arteries for their blood supply. The vascular network of the myoma is an independent vascular network without a perfect reserve traffic vascular network. After uterine artery embolization, the myoma tissue has no reserve traffic branch to provide blood flow for it, which leads to acute ischemia and hypoxia of myoma and degeneration and necrosis of myoma cells. Uterine smooth muscle is in a quiescent state in adult women, has a low metabolic rate, and has a high tolerance to ischemia and hypoxia. Uterine fibroids are newborn tumors that grow progressively at a rate of 1-2 cm/year under normal conditions. The smooth muscle cells of fibroids are in a constant state of division and require more blood supply and have a lower tolerance to ischemia and hypoxia, so they first degenerate and necrotize to a significantly higher degree than normal smooth muscle cells.  The etiology of uterine fibroids is unclear, but various studies have found an association with increased estrogen. However, no statistically significant differences have been found in the monitoring of estrogen in peripheral blood of patients with uterine fibroids, and normal women. In other studies, it was found that the local estrogen level in fibroids was 20% higher than in normal myometrium, and the level of estrogen receptors was also 20% higher, and the utilization of estrogen was also 20% higher, therefore, the high local estrogen level and the increased utilization of estrogen in myometrium are the causes of fibroids. In the process of growth, myoma cells also secrete a certain amount of estrogen and other hormones, which supply the growth of myoma cells on one hand and stimulate the surrounding myometrial tissue on the other hand, and the long-term stimulation leads to the emergence of new myomas, so that myoma is mainly multiple. After embolization, necrosis of the fibroid cells leads to the loss of autocrine estrogen secretion and stimulation of the surrounding normal myometrial tissues. No recurrence of fibroids or a low recurrence rate has been observed over a long period of time after arterial embolization of uterine fibroids in clinical practice.  In summary, embolization of the uterine artery can block the blood supply to the fibroids and achieve myoma de-vascularization. The normal myometrium has well-established vascular traffic branches, and embolization does not cause extensive necrosis of the myometrium. After embolization, myoma cells are subjected to continuous ischemia and hypoxia because there is no blood supply to the myoma. The necrosis of myoma cells leads to the disappearance of the autocrine phenomenon of myoma, so the recurrence of myoma will not occur for a longer period of time.  The advantages of interventional embolization of uterine fibroids: precise efficacy: except for individual types, it has good efficacy for all types and sizes of fibroids, and the fibroids shrink significantly after embolization and remain stable, with low recurrence rate, and obvious elimination of clinical symptoms for those with mainly bleeding symptoms.  Small trauma: Only a small incision of 2-3mm is made on the surface of the femoral artery, which is less traumatic than traditional open surgery and laparoscopic surgery, and the technical operation is simpler and the postoperative complication rate is lower.  Uterine function and normal fertility can be preserved.  High patient satisfaction: Foreign scholars showed through the results of the post-treatment satisfaction survey of two groups of patients that 71% to 94% of women were willing to choose this treatment modality again, and only 6% of women were willing to choose other treatment methods. Since bleeding was controlled, menstruation returned to normal, and symptoms such as anemia, pelvic pressure and discomfort improved after treatment, it led to a significant improvement in the quality of life for most patients.  The hospitalization time is short and recovery is fast, and you can get out of bed 20 hours after the operation.  The treatment does not affect other treatments, in other words, even if embolization fails, patients can receive other treatments.  Interventional treatment of uterine fibroids has been carried out in China for nearly a decade, with mature technology and a large number of case reports showing its efficacy, and has gradually been accepted by the majority of patients with uterine fibroids, and has become the treatment of choice in developed areas of China