Interventional therapies in gynecology

  In recent years, with the development of medical technology and the increasing demand for quality of life, minimally invasive has become a direction and a demand. Interventional therapy has been carried out intensively and its clinical use is becoming more and more widespread, especially in the field of obstetrics and gynecology, where it has become the most important treatment method chosen by clinicians and patients because of its many advantages.  Miss Zhang, 28 years old, was found to have an incisional pregnancy (i.e., the embryo was laid on the tiny gap of the uterine incision scar after the cesarean section, which is a rare ectopic pregnancy) when she was more than 2 months pregnant and was ready to terminate the pregnancy. When a large amount of bleeding occurred during aspiration in the hospital, the obstetrician and gynecologist, together with an interventional specialist, performed a uterine vascular intervention to block the arterial vessels of the uterus and stop the bleeding in time. If traditional treatment had been used, the uterus would have been removed, which would have been a very painful option for the woman.  Another 32-year-old woman with the surname Deng was in critical condition after a cesarean section due to poor uterine contraction and developed postpartum hemorrhage of more than 2,500 mL and an exudate in the abdominal cavity. In order to reduce the bleeding and exudate and avoid hysterectomy to save her life, the woman was finally out of danger and avoided serious consequences after the obstetrician-gynecologist and radiologist used interventional therapy to treat her.  Knowledge about interventional therapy Interventional therapy is a clinical application discipline in which specific instruments are introduced into the body lesions for treatment through tiny incisions or human body cavities under the guidance of diagnostic radiology equipment (digital subtraction X-ray machines, CT machines, MRI machines and conventional X-ray machines, etc.). Since the 1990s, interventional therapy has been applied to the field of obstetrics and gynecology, and since then, the surgical instruments have become more and more refined, the damage has become less and less, and the technology has become more mature and more widely used. Data show that in a tertiary care hospital, one out of every 10 patients using interventional therapy is usually an obstetrics and gynecology patient, i.e., 10% of patients are used in obstetrics and gynecology.  In general, interventional therapy has the following advantages: it does not require incision, is precise, and has high patient safety; it is less invasive, faster recovery, and more effective, and protects and preserves normal tissues and organs to the greatest extent; especially in the treatment of obstetrical and gynecological diseases, it directly replaces the original surgery and preserves the uterus; in addition, for malignant tumors for which there is no curative method, interventional therapy can confine the drugs to the site of the lesion as much as possible. In addition, for malignant tumors for which there is no cure, interventional therapy can confine the drugs to the lesions as much as possible, thus reducing the side effects on the body and other organs.  At present, interventional therapy is mainly used in obstetrics and gynecology for three types of diseases: First, advanced gynecological tumors, such as ovarian cancer, cervical cancer, and cancers with pelvic and lymphatic metastases that cannot be removed. Through interventional treatment, the symptoms can be reduced, the patient’s quality of life can be improved, the tumor can be reduced in size, and the chance of secondary surgery can be improved.  Second, it is common gynecological diseases, such as uterine fibroids, endometriosis, tubal incompetence and adenomyosis. Through interventional treatment, the uterus can be preserved, and the patient’s body recovers quickly after the operation, and can be discharged from the hospital in 3-5 days in general.  Third, it is emergency obstetrical and gynecological surgery, such as postpartum hemorrhage, ectopic pregnancy, hysterectomy, etc. Through interventional treatment, the uterus can be preserved, saving lives and avoiding serious consequences.  It is applicable to any patients except those with severe heart, lung and kidney dysfunction who cannot use interventional therapy. And compared to surgery, interventional therapy is much less risky, with an incision of only 2 mm, less damage and high safety. As for postoperative reactions, some patients may experience fever after the procedure, which is related to the medication used and can be treated symptomatically by the clinician.  The cost of interventional treatment is relatively high. Usually, for the treatment of obstetrical and gynecological diseases such as uterine fibroids, the operation costs 3,000 to 5,000 RMB, while for the treatment of gynecological tumors, the operation costs 11,000 to 12,000 RMB. Of course, due to the different economic levels in different places and the different surgical equipment and drugs chosen, their surgical costs will vary. Therefore, patients can consider whether to choose interventional treatment according to their physical condition, disease condition, economic condition and age.