Minimally invasive treatment of uterine fibroids
With the development of modern society, there are more and more patients with uterine fibroids, and their incidence shows two major trends: first, the incidence is getting higher and higher, according to incomplete statistics, 1 out of 4-5 women over 30 years old have the disease, becoming the veritable first tumor of women; second, the age of incidence is getting younger and younger, the youngest among the patients we treated is 21 years old. Therefore, the prevention and treatment of uterine fibroids must be paid attention to. Wang Shaoguang, Department of Gynecology, Yantai Yuhuangding Hospital
The traditional treatment for uterine fibroids is surgical resection, with the three main procedures being total hysterectomy, hysterectomy and myomectomy, which can be done through three routes: transabdominal, transvaginal and translaparoscopic. The first two are done by removing the fibroids along with the normal uterus, while the latter is done by cutting open the uterus and digging out the fibroids, either way at the cost of damaging the uterus or removing it. The uterus is a very important organ for women because, in addition to its well-known reproductive and menstrual functions, it also has very important endocrine and immune functions and supports the pelvic floor structure.
With the development of society and the progress of the times, women’s awareness of their health is no longer limited to the treatment of diseases, but requires safer, less damaging and organ-preserving treatments; while the development of medicine is also the pursuit of the application of more advanced and scientific treatments and methods to treat diseases. The emergence of minimally invasive medicine is the product of the combination of the two. Its medical method is mainly used to “treat the human body” DD to solve the problem of diagnosing and treating diseases with the least possible trauma; at the same time, “concern for the human heart” DD to adjust the patient’s mentality and correct the problem of the heart. The problem of “caring for the human heart”.
Minimally invasive interventional treatment of uterine fibroids is the specific application of minimally invasive medicine in the field of obstetrics and gynecology, which perfectly embodies the concept of minimally invasive treatment and realizes the dream of treating fibroids without damaging the uterus, making the treatment of uterine fibroids more humane.
I. What are the dangers of fibroids?
Specially located fibroids such as submucosal, interstitial fibroids or larger subplasma fibroids can be clinically harmful such as: (1) most commonly, menstrual disorders and excessive menstruation leading to anemia. (2) Enlarged myomas lead to compression symptoms such as: urinary urgency, frequent urination, increased nocturia, difficulty in passing stool, and painful lower abdominal cramping. (3) Huge fibroids compress the pelvic floor muscles for a long time and cause pelvic floor laxity, which may lead to prolapse of internal organs in old age, such as bladder bulge and incontinence. (4) Myoma itself secretes some hormonal materials which we call autocrine phenomenon of tumor, leading to the occurrence of related diseases: such as hypertension, diabetes, and even homologous tumors such as: breast hyperplasia, breast cancer, endometrial cancer, etc. (5) Psychological stress leads to neurasthenia, etc. (6) Malignant transformation of fibroids.
Second, what are the principles of selection for the treatment of fibroids?
According to the principles of minimally invasive gynecological therapeutics, the principles of minimally invasive treatment should be followed when choosing the treatment for uterine fibroids, namely.
(1) Optimal clinical efficacy;
(2) Minimal surgical incision;
(3) the shortest treatment time;
(4) Minimal organ damage;
(5) Minimal postoperative reactions;
(6) Fastest recovery time;
(7) Minimal psychological trauma.
Specifically, if drug treatment is effective, surgery is not necessary; if interventional treatment is also effective, there is no need to resort to open surgery.
What is minimally invasive gynecological treatment? How does it differ from traditional gynecological treatment?
Minimally invasive gynecological treatment is an emerging science in recent years, which is part of minimally invasive medicine, and its medical method is mainly used to “treat the human body” DD to solve the problem of diagnosing and treating diseases with the least possible trauma; at the same time, it “cares for the heart” DD to adjust The patient’s mindset and the problem of correcting the heart.
Traditional gynecological treatment Minimally invasive gynecological treatment
Medical model Biomedical model Biopsychosocial medical model
Medical Subjects Patient-centered and Human-centered
Doctor-centered Patient-centered
Medical model Patients revolve around doctors Doctors revolve around patients
The method is chosen according to the doctor The method is chosen according to the disease
Medical goals Treatment of disease Prevention of disease, minimally invasive medical disease Attention to mental health
Fourth, the most humane uterine fibroids treatment method DD minimally invasive interventional treatment
At present, the treatment of uterine fibroids advocates humanized treatment, that is, choosing the best treatment method for patients according to their conditions, among which minimally invasive interventional treatment is one of the most humanized methods, whose full name is uterine artery embolization. Unlike traditional surgical treatment, which treats the disease at the expense of normal organs, minimally invasive interventional techniques treat the disease without damaging or minimizing normal organs, in line with the current principles of minimally invasive gynecology.
This technology has been applied in obstetrics and gynecology clinics for nearly 40 years and in the treatment of uterine fibroids for more than 10 years. At present, hundreds of thousands of patients with uterine fibroids have benefited from it worldwide, and some patients with fertility requirements have fulfilled their dreams of becoming mothers. The procedure involves cutting a rice-sized hole at the root of the patient’s thigh, inserting a special catheter into the blood supply artery of the fibroid and then applying a biodegradable embolic agent to embolize the fibroid artery, causing the fibroid to necrosis due to ischemia and hypoxia, usually without damaging the normal uterus. After surgery, the necrotic fibroids are either discharged vaginally or absorbed by the body.
Studies have shown that as long as the appropriate embolic agent is chosen, medical evidence of complete necrosis of fibroids can be found after interventional treatment of fibroids as large as 25 cm in diameter and as small as 0.2 cm in diameter, and reliable results have been seen clinically for both single and multiple fibroids, and for subplasmalemma, intermural and submucosal fibroids.
V. What is the difference between minimally invasive interventional treatment for fibroids and traditional surgical treatment?
The key to treating fibroids is to make the fibroids die, shrink and disappear, and the clinical symptoms caused by them will also disappear naturally. The traditional treatment method is to kill and destroy the fibroids through surgery, while the minimally invasive interventional treatment method is to “starve” the fibroids to death by embolizing the blood vessels supplying them with blood and oxygen, which also achieves the purpose of treatment, but unlike the traditional treatment, it does not damage the uterus. Therefore, the fundamental difference between minimally invasive interventional treatment and traditional gynecological surgery is that, on the premise of obtaining the same clinical efficacy, minimally invasive treatment damages less or no normal organs; at the same time, it pays attention to patients’ psychology during the treatment process, focusing on the manifestation of “concern for the heart” DD to regulate the mentality and correct the inner problems.
Is minimally invasive interventional treatment for uterine fibroids painful?
Interventional treatment is done under anesthesia, so there is no pain during the operation.
How long does minimally invasive interventional treatment for fibroids take?
The procedure takes less time, 20 minutes at the earliest, and can be completed in about 40-50 minutes in general.
What will be the reaction after minimally invasive intervention for uterine fibroids?
This is a normal reaction after the intervention, which can be treated after symptomatic treatment.
What should I pay attention to after minimally invasive interventional treatment for uterine fibroids?
There are no special requirements after interventional therapy, generally you can eat 6 hours after the operation, 24 hours you can move freely; 3-5 days you can be discharged from the hospital, 7-10 days rest can be normal work.
What is the effect of minimally invasive interventional treatment for uterine fibroids?
After ten years of observation, minimally invasive interventional treatment for uterine fibroids is already a mature technology, and 90% of patients have achieved better results clinically, which has become the preferred method to replace hysterectomy for uterine fibroids abroad.
11. Will myoma recur after minimally invasive interventional treatment?
The fibroids appear necrosis after interventional treatment, so there is no problem of recurrence of the original fibroids, which is supported by the cases at home and abroad and our data. Since the uterus is still normal, there is still a chance of fibroid regeneration. According to statistics, the 5-year regeneration rate is about 5%, which is lower than the recurrence rate after myomectomy (20% recurrence rate 2 years after surgery).
Can I have children after minimally invasive intervention for uterine fibroids?
Fibroids themselves can cause infertility, the incidence of which is 25%-40%. With the disappearance of fibroids after interventional treatment, the factors that cause infertility due to fibroids disappear and the patient’s chance of conception increases. There have been reports of pregnancy and delivery of normal fetuses after interventional treatment in China and abroad, and we have also had cases of pregnancy after treatment.
Trivia.
I. Functions of the uterus.
According to recent medical studies, the uterus has the following functions.
(1) Menstrual function DD a sign of female health and youth;
(2) fertility function DD to maintain human survival reproduction important guarantee;
(3) endocrine function DD secrete known or unknown female hormones by itself; at the same time, maintain the blood supply of ovaries and provide material guarantee for the normal secretion of ovaries;
(4) Immune function DD is a link in the immune chain of human body;
(5) Fixed function DD is an important part of female pelvic floor structure, involved in the support of female pelvic floor structure, to avoid the sagging of internal organs.
Second, what should I do if I have uterine fibroids?
The first step should be to clarify the diagnosis, which can be confirmed by gynecological examination and ultrasound examination by experienced obstetricians and gynecologists, and MRI (magnetic resonance imaging) can be more helpful when there are difficulties.
The second step is to learn about fibroids on your own. The easiest way to find out about fibroids is to use the internet and enter “fibroids” into the website search system and websites and reports related to fibroids will appear.
The third step is the systematic evaluation of fibroids by a professional obstetrician and gynecologist, which includes: (1) the degree of danger of fibroids and the need for further examination and treatment; (2) the patient’s own situation and requirements; and (3) the advantages and disadvantages of various treatment methods. Through the series of evaluation and examination, we will decide the most suitable “individualized” treatment method for you.
The fourth step is to choose the right time to implement the treatment.
How to avoid the occurrence of uterine fibroids?
This is a difficult problem for several reasons: (1) The exact cause of uterine fibroids is still not very clear, but a lot of information shows that it is related to high estrogen levels in the patient’s body. (2) Increase of endogenous estrogen: Due to the improvement of living standard, the years of menstruation of women are significantly longer than before; pregnancy and breastfeeding can avoid estrogen attack on the uterus, and the decrease of childbirth makes the uterus under estrogen attack significantly longer than before. (3) Increase of exogenous estrogen: mainly the increase of hormone pollution and the increase of feed animals lead to the increase of human exogenous estrogen intake. Therefore a lighter type of diet and eating deep-sea fish can help reduce the occurrence of fibroids.
Although it is difficult to avoid the occurrence of fibroids, we can detect them and take appropriate measures in time. For unmarried and sexless women, annual ultrasound examination after the age of 20 and semi-annual or annual gynecological examination for married or sexually active women are necessary to help early detection of fibroids and other gynecological diseases.