What is uterine fibroids?
Uterine fibroids, known as the “first tumor of obstetrics and gynecology”, are the most common gynecological tumor in women of childbearing age, and the incidence of uterine fibroids in women over 30 years old is as high as 20% to 30%. Since uterine fibroids are mainly made by the proliferation of uterine smooth muscle cells, with a small amount of fibrous connective tissue existing as a supporting tissue, it is more accurate to call them uterine smooth muscle tumors. The abbreviation is uterine fibroids. The common symptoms are frequent and excessive menstruation and prolonged periods, which increase the incidence of anemia and decrease the physical fitness of the patient, seriously affecting the health of the patient.
What are the causes of fibroids?
The cause of uterine fibroids is still not well understood and may involve a complex interaction between cellular mutations in the normal muscle layer, sex hormones and local growth factors. Based on a large number of clinical observations and experimental results, it has been shown that uterine fibroids are hormone-dependent tumors, and estrogen is the main factor contributing to the growth of fibroids, and it has been hypothesized that human placental prolactin (HPL) can also synergize with the mitogenic effects of estrogen.
What are the symptoms in patients with uterine fibroids?
Most patients are asymptomatic and are only occasionally detected during pelvic examination or ultrasonography. The symptoms, if any, are closely related to the location and speed of growth, the presence of degeneration and the presence of complications, but are relatively less related to the size and number of fibroids. Those with multiple subplasma myomas may not be symptomatic, while a small submucosal myoma can often cause irregular vaginal bleeding or excessive menstruation.
Common clinical symptoms include.
(1) Uterine bleeding is the most predominant symptom of fibroids and occurs in more than half of patients. The most common symptoms are cyclic bleeding, which can be manifested as increased menstrual flow, prolonged periods or shortened cycles. It may also manifest as irregular vaginal bleeding without a menstrual cycle. Uterine bleeding is more common with submucosal and interstitial myomas, while subplasmalemma rarely causes uterine bleeding.
(2) Abdominal mass and pressure symptoms of myoma gradually grow, when it makes the uterus enlarge more than the size of the uterus in 3 months of pregnancy or is a large subplasma myoma located at the bottom of the uterus, a mass can often be found in the abdomen, more obvious in the early morning when the bladder is full. The mass is solid, movable and painless. 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 those in the isthmus or posterior lip of the cervix, can compress the rectum, causing dyspareunia and discomfort after defecation; huge broad ligament fibroids can compress the ureter and even cause hydronephrosis.
(3) Pain Generally, fibroids do not cause pain, but many patients may complain of lower abdominal cramping and back pain. Acute abdominal pain can occur when subplasma fibroids are twisted or when red degeneration of fibroids occurs, and it is not uncommon for fibroids to be combined with endometriosis or adenomyosis, which can cause dysmenorrhea.
(4) Increased leucorrhea is caused by the enlargement of the uterine cavity, the increase of endometrial glands and the pelvic congestion. If the submucosal fibroids of the uterus or cervix become ulcerated, infected or necrotic, bloody or purulent leucorrhea may be produced.
(5) Infertility and miscarriage Some patients with uterine fibroids are infertile or prone to miscarriage. The effect on conception and pregnancy outcome may be related to the growth site, size and number of fibroids. Large fibroids may cause deformation of the uterine cavity, preventing the implantation of the gestational sac and the growth of the embryo; fibroids compressing the fallopian tubes may lead to dysfunctional lumen; submucosal fibroids may 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 can be caused by prolonged excessive menstruation or irregular vaginal bleeding, and more serious anemia is seen in patients with submucosal fibroids.
(7) Other rare patients with uterine fibroids can develop erythrocytosis and hypoglycemia, which are generally thought to be related to the production of ectopic hormones by the tumor.
Uterine fibroids smaller than 5 cm or without symptoms can be observed without treatment, but early treatment is recommended once symptoms such as excessive menstrual flow, anemia, pressure and discomfort, and interference with conception occur.
What is minimally invasive interventional treatment for fibroids?
In the past, uterine fibroids were mainly removed surgically, but young patients are eager to preserve uterine function and improve their quality of life. Now with a new interventional treatment method, DD uterine artery embolization (UAE), to treat fibroids, patients can eliminate tumors and lesions without surgery and avoid the pain of uterine removal, making the dream of doctors and patients to treat fibroids for years to preserve the uterus a reality. Compared to patients with fibroids treated with surgery, women treated with uterine artery embolization have shorter hospital stays, less trauma, faster recovery, fewer complications, better outcomes, preservation of uterine function and normal fertility, and no interference with other treatments after treatment.
UAE is a new minimally invasive treatment for uterine fibroids that preserves uterine function and normal fertility, replaces hysterectomy and myomectomy in young patients, preserves the integrity of the uterus, is more in line with the biological requirements of the human body, and transforms the treatment of disease from organ-destructive to organ-protective surgery.
The application of interventional therapy to the conservative treatment of uterine fibroids is a major event in interventional radiology and obstetrics and gynecology, and a milestone in the conservative treatment of uterine fibroids.
How is minimally invasive interventional treatment for uterine fibroids performed?
The procedure of interventional treatment for uterine fibroids is as follows: the femoral artery is touched at 0.5 cm below the midpoint of the inguinal ligament as a puncture point, and the puncture enters the arterial system of human body. -The uterine artery is inserted through the catheter and a certain size and amount of embolic particles are inserted to embolize the blood vessels supplying the uterine fibroids and certain peripheral vessels of the normal uterine artery branches.
A diagram of the interventional model for uterine fibroids, in which the catheter selectively enters the blood supplying artery of the fibroid and then embolizes it
In vitro magnification of the PVA microspheres we selected for embolization and their embolic response under microscopy. Compared with conventional embolization particles, the microspheres are more likely to enter the vascular end of the fibroids, and the efficacy is more complete and durable.
What is the principle of minimally invasive interventional treatment for uterine fibroids?
The treatment principle of interventional embolization of uterine fibroids.
(1) It can directly cut off the blood supply of fibroids, and the tumor will become ischemic and necrotic, gradually shrink and become smaller, and improve the symptoms of compression caused by the occupancy of fibroids.
(2) Uterine fibroids are sex hormone-dependent, and estrogen can promote the growth of fibroids. Cutting off the blood supply to the fibroids can block estrogen from entering the fibroids through the blood flow, and the estrogen level of the fibroids will drop significantly, forming a local hormonal environment similar to menopause, and the fibroids will shrink further.
(3) After uterine artery embolization, the blood supply to the uterus decreases significantly, the endometrial growth is inhibited, and the menstrual flow decreases and the menstrual period returns to normal. Anemia was gradually improved and restored.
What is the efficacy of minimally invasive interventions for uterine fibroids?
Several large foreign studies have shown that in short and medium-term follow-up observations (5-14 months) of patients after uterine artery embolization, there is a very significant decrease in symptom scores such as anemia, pressure, and pain, while at the same time life status scores such as physical strength, mood, self-awareness, and sexual function are significantly improved compared to preoperative scores, all reaching or approaching 100. Compared to conventional gynecologic resection, there were no significant differences in long-term symptom improvement or life status scores, but patients who underwent uterine artery embolization recovered more quickly from postoperative pain and other discomfort, had shorter hospital stays, and returned to family, society, and work sooner. The vast majority of fibroids (more than 90%) shrink significantly in size in about 6 months and remain there.
How safe is interventional treatment for fibroids?
Fibroid interventions are very less harmful to the body because they are minimally invasive, with no wounds or bleeding. A common concern is whether it will affect ovarian function causing premature aging. According to foreign literature, there is no significant difference in hormone levels after fibroid embolization and hysterectomy and fibroid removal. Another concern is whether uterine fibroid embolization affects pregnancy, and this is a clear conclusion: that is, uterine fibroid embolization does not affect pregnancy. In one case, the embolization of fibroids was done without the knowledge of pregnancy, but a healthy baby was delivered at full term. Therefore, embolization of fibroids is a very safe treatment. The incidence and severity of postoperative complications are much lower than those of conventional treatments such as hysterectomy and myomectomy.
What are the contraindications and indications for interventional treatment of uterine fibroids?
Contraindications.
1, severe liver and kidney dysfunction.
2, severe cardiovascular disease.
3, severe disorders of coagulation mechanism.
4, allergy to contrast agents and anesthetics.
5.Uterine fibroids with malignant tendency.
Indications.
1, symptomatic uterine fibroids or those with tumor diameter of 5 cm or more although asymptomatic.
2.Patients with uterine fibroids who are unwilling to undergo surgical treatment.
3.Uterine fibroids combined with heart disease, diabetes and other hysterectomy surgery risk.
What are the advantages of interventional treatment for uterine fibroids?
Uterine artery embolization therapy shows great potential and unique advantages in the treatment of symptomatic uterine fibroids
1. The biggest advantage is that it can preserve uterine functions, such as normal menstruation, pregnancy and delivery, and does not affect conception; it avoids the traumatic blow of surgery and a series of postoperative complications, and its effect on symptom improvement is comparable to that of surgery.
2. It is easy for patients to accept because of the small trauma, quick recovery and short hospitalization time.
3. It is easier and more economical than traditional surgical treatment and saves money. Blood transfusion is generally not needed.
4. Finally, the advantage of this treatment is that it leaves a considerable margin for oneself, even if embolization fails, surgery and drug treatment can still be applied.
What are the postoperative reactions after interventional treatment for uterine fibroids? How to manage them?
Minimally invasive interventional treatment for uterine fibroids, because of minimal trauma and no need for anesthesia, generally has no particularly serious adverse reactions during and after surgery, and the following reactions may occur.
1. Ischemic pain: It is the most common adverse reaction. 88, 66% of patients will have different degrees of lower abdominal distension and cramping pain after treatment, which lasts for different periods of time, ranging from 5-6 hours on the short side to 3 days on the long side, and can be relieved by giving symptomatic treatment for pain relief.
2, fever: 25% of patients, especially patients with large myoma, can have a low fever temperature around 38°C within a week after embolization. Generally, no special treatment is needed, and it will subside on its own after a week.
3.Soreness and weakness of lower limbs: 60% of patients feel soreness and weakness of both lower limbs after embolization, which will disappear naturally after about 20 days.
4.Irregular vaginal bleeding: A small amount of irregular vaginal bleeding can occur in a small number of patients after embolization, accompanied by endometrial shedding, which may be related to the insufficient blood supply to the uterus to maintain the endometrial growth after embolization.
5.Vaginal dislodgement of fibroids: It is seen in patients with submucosal fibroids, which can be dislodged from the vagina after ischemia. If the fibroids are large enough to block the vaginal opening, they can be removed from the vagina in the obstetrics and gynecology department.
Besides fibroids, what other diseases can be treated by uterine artery embolization?
Another common disease in women of childbearing age, myometriosis, can also be treated by a minimally invasive intervention called uterine artery embolization. The greatest pain caused by myometriosis is the unbearable and severe menstrual pain, which is significantly reduced by the next menstrual period after treatment. Other treatment methods, such as medication with too many side effects and surgery requiring complete removal of the uterus, are not very suitable for young and middle-aged female patients.
Likewise postpartum hemorrhage, placental implantation, ectopic pregnancy, scar pregnancy and other gynecological emergencies can be treated by uterine artery embolization for the purpose of preserving the uterus, treating the disease and saving lives.