Uterine fibroids are the most common benign tumors of the female reproductive organs and the most common tumors in the human body, mostly seen in women aged 30-50, most common in those aged 40-50 and rare in those under 20 years old. It is believed that the growth of uterine fibroids is related to the high level of estrogen in the body.
1. Follow-up observation: If the fibroids are small and asymptomatic, they usually do not require treatment. Especially in patients near menopausal age, the estrogen level is low and the fibroids may shrink or disappear naturally.
2.Medication: If the enlarged uterus resembles the size of a pregnant uterus for 2 months or less, the symptoms are not obvious or mild, and the near menopausal age and general condition cannot be operated, symptomatic treatment can be given, commonly used drugs are androgens, gonadotropin-releasing hormone similar drugs, antagonistic progesterone drugs (mifepristone), etc.
3.Surgical treatment: If the uterus is ≥ 2.5 months size of the pregnant uterus or the symptoms are obvious to cause secondary anemia, surgery is often required, surgical methods are.
(1) myomectomy: for patients under 35 years old, unmarried or married without children, who wish to retain their reproductive function.
(2) Hysterectomy: Hysterectomy is performed for patients with large fibroids, obvious symptoms, ineffective medication, no need to preserve the reproductive function or suspected malignant change.
In recent years, with the development of medical level, especially the development of minimally invasive surgery, surgical treatment of uterine fibroids under laparoscopy or hysteroscopy has become a reality, and the operation has the advantages of small incision, beautiful, little trauma and fast recovery, so it is welcomed by the majority of patients.
4, psychological guidance: most of the patients who need surgery have a mental burden, showing fear of surgery, lack of knowledge of the disease, fear of whether degeneration and loss of female characteristics after surgery; secondly, there are also economic concerns, often depressed, irritable and depressed. This requires nursing staff to establish a good nurse-patient relationship by talking with the patient, communicating in a timely manner, constantly providing psychological comfort and encouragement, and discussing with their husbands to tell them about the mode of surgery and the treatment effect and the information that sex life will not be affected after surgery, so that they can eliminate their worries and increase their confidence in treatment. Use the cured case to teach and eliminate their bad psychological emotions, so that they can actively cooperate with the medical staff and make all the preoperative preparations, so that the patient is in the best condition to accept the surgery.
5.Pre-operative preparation: including skin, intestine, vaginal preparation and indwelling urinary catheter.
(1) Skin preparation range: up to the subxiphoid process, down to the upper 1/3 of the two thighs, both sides up to the mid-axillary line, and the skin of the vulva.
(2) Intestinal preparation: preoperative evening and morning of the operation day, enema with 1%-2% soap and water. In recent years, mannitol has been used for preoperative intestinal preparation with better results. The night before surgery, dilute 500ml of 20% mannitol to about 1500ml orally. Because mannitol is a hypertonic drug, it can absorb water from the intestinal wall after oral administration, promote intestinal peristalsis, play an effective diarrhea, and achieve the effect of intestinal cleansing, but it is prohibited for those with cardiac and renal insufficiency.
(3) Vaginal preparation: 3 days before the operation, vaginal douche is given once a day. For total hysterectomy, 2% gentian violet is applied to the cervix and posterior vaginal vault to mark and disinfect the vagina for the operation.
(4) Routine indwelling catheterization to avoid accidental bladder injury during surgery.
6.Observation of condition.
(1) Monitor vital signs: visit the ward every 15-30 minutes. Measure the vital signs once every 4h, after the vital signs are stable, change to measuring twice a day.
(2) Observe whether there is any exudation of the dressing and vaginal bleeding in the operation area. Postoperatively, a sandbag was given to the abdomen for 6h to reduce bleeding.
(3) Observe the nature and degree of pain and give painkillers according to the condition.
7.Instructions on body position and activities.
(1) Within 6h after epidural anesthesia, the patient should be placed in a flat position with the pillow removed, and after 6h in a semi-recumbent position, which is conducive to pelvic drainage and confinement of infection.
(2) Encourage the patient to turn over in bed and move the limbs to prevent intestinal adhesions and venous thrombosis of the lower limbs.
(3) Encourage the patient to leave bed after 24h, first sit up in bed, and then get out of bed after no discomfort.
8. Dietary instruction.
(1) Before the anus is exhausted, eat sugar-free and milk-liquid food and drink a small amount of orange juice to promote exhaustion and avoid abdominal distension.
(2) Enter liquid diet on the first day after anal discharge, semi-liquid diet on the second day, and general diet on the third day, avoiding foods with high sugar content to prevent abdominal distension.
(3) Light, easily digestible, high-protein, high-vitamin nutrient-rich food is appropriate to ensure the normal needs of the body and to enhance the body’s ability to resist disease and tissue repair.
9.Discharge instruction.
(1) For conservative treatment, follow up every 3-6 months to observe whether the myoma is enlarged and whether degeneration occurs.
(2) For total hysterectomy, 3 months of rest is usually required; for subtotal hysterectomy, myomectomy and cathartic hysterectomy, 1 month of rest is usually required.
(3) The amount of vaginal bleeding should be closely observed within 2 weeks after surgery, usually not exceeding the amount of menstruation, and if it exceeds the amount of menstruation, you should come to the hospital promptly for examination to identify the cause of bleeding.
(4) Prohibit tub bathing and sexual life for 3 months after total hysterectomy; prohibit tub bathing and sexual life for 1 month after subtotal hysterectomy and negative surgery to avoid affecting tissue healing and avoid heavy physical labor.
(5) Strengthen nutrition, diet is light, easy to digest, high protein, high vitamin nutrient-rich diet. The diet should contain crude fiber to prevent constipation.
(6) Ensure regular follow-up and come to the outpatient clinic for review 1 month after surgery.
(7) Keep the vulva clean and dry, change underwear and sanitary pads in time.