Fibroids are one of the most common benign tumors in the female reproductive organs and one of the most common tumors in the human body, also known as fibroids and uterine fibroids. Since uterine fibroids are mainly caused by the proliferation of uterine smooth muscle cells, with a small amount of fibrous connective tissue existing as a kind of supporting tissue, it is more accurate to call them uterine smooth muscle tumors. The abbreviation is uterine fibroids. Its clinical manifestations include.
1.Uterine bleeding
It may be manifested as increased menstrual flow, prolonged menstrual period or shortened cycle, or irregular vaginal bleeding without menstrual cycle.
2. Abdominal mass and pressure symptoms
When the fibroid grows to a certain size, it can cause symptoms of pressure on the surrounding organs. Anterior wall fibroids close to the bladder can cause frequent and urgent urination; huge cervical fibroids compressing the bladder can cause dyspareunia or even urinary retention; posterior wall fibroids, especially the isthmus or posterior cervical lip fibroids, can compress the rectum, causing dyspareunia and discomfort after defecation; huge broad ligament fibroids can compress the ureter and even cause hydronephrosis.
3.Pain
Many patients may complain of lower abdominal swelling and back pain.
4.Increased leucorrhea
5.Infertility and miscarriage
Giant fibroids can cause deformation of the uterine cavity, preventing the implantation of the gestational sac and the growth and development of the embryo; fibroids can compress the fallopian tubes, resulting in lumen incompetence; submucosal fibroids can prevent the implantation of the gestational sac or affect the entry of sperm into the uterine cavity. The rate of spontaneous abortion is higher in patients with leiomyoma than in the normal population, with a ratio of about 4:1.
6.Anemia
Blood loss anemia can be caused by prolonged excessive menstruation or irregular vaginal bleeding.
Young patients with asymptomatic or mild symptoms or patients nearing menopause usually do not need treatment or are treated with drugs (hormone) only, but hormone treatment can cause endocrine disorders and myoma grows rapidly after stopping the drug. Although myomectomy (lumpectomy or caesarean section) can preserve the uterus, it is often overwhelming for larger or more numerous fibroids and has a recurrence rate of more than 20%. Secondary total hysterectomy can keep the vagina anatomically and functionally intact, but the biggest disadvantage is the possibility of cervical stump cancer, and it still has some impact on women’s psychology and physiology.
Total hysterectomy has a greater psychological and physiological impact on the patient. Uterine artery embolization for uterine fibroids is a new method developed in the last decade or so (former US Secretary of State Condoleezza Rice underwent the procedure). The principle is to embolize the uterine arteries bilaterally to cause ischemia and necrosis of the fibroids, thus shrinking or fibrosing the fibroids for the purpose of treatment while preserving the uterus.
This method is suitable for women of childbearing age with symptoms, including.
1. Excessive menstrual flow, especially if accompanied by anemia.
2. chronic pelvic, leg or back pain caused by fibroids, or with other discomfort.
3. urinary symptoms caused by compression of the ureter and bladder by uterine fibroids.
4. the patient wishes to preserve the uterus and reproductive function
5.Recurrence of fibroids after myomectomy.
In general, this method of treatment is not considered in patients with fibroids that are too small (<75px) or too large (>250px), subplasmic fibroids with a tipped uterus and imminent menopause.
The basic treatment is to insert a catheter about 1 mm thick from one femoral artery to both uterine arteries in sequence and then embolize them with polyvinyl alcohol (PVA) pellets (500-700 microns in diameter is appropriate), usually within 1 hour. The time of treatment is preferably within 1 week after the end of menstruation.
Most of the patients have post-embolization syndrome after uterine artery embolization, including pelvic pain, nausea, vomiting, fever, and increased white blood cell count, especially pelvic pain is prominent, but most of them can be tolerated, and anti-inflammatory and analgesic symptomatic treatment can be given.