1.Uterine fibroids overview
Uterine fibroids, also known as uterine smooth muscle tumors, are the most common benign tumors in the female reproductive organs, most commonly found in middle-aged women, with an incidence of about 38%-42%. Symptomatic patients may have increased menstrual flow with blood clots, prolonged menstrual cycle, vaginal bleeding, combined infection and ulceration, infertility, frequent urination, urgent urination, even urinary retention, anemia, lumbosacral pain, and in a very small number of patients, cancer may occur.
2.Uterine fibroids classification and growth mode
Uterine fibroids grow out from the myometrium, and most of them occur in the myometrial wall at first. According to the relationship between fibroids and the myometrial wall, they can be divided into: subplasmic fibroids (20%-30%), submucosal fibroids (10%-15%), and interstitial fibroids (60%-70%). The main feature is that the fibroid develops toward the plasma membrane and protrudes from the surface. If it continues to grow outward, it becomes a subplasmic fibroid with a tip, and once it is twisted, the blood is blocked, the tip breaks off, and the fibroid adheres to the neighboring organs and continues to live and grow, becoming a parasitic tumor. Subplasma fibroids tend to grow towards the broad ligament, which can compress the adjacent organs, such as ureter and surrounding blood vessels, and bring many complications to patients. It also makes diagnosis and treatment more difficult, and can cause obstructive obstructed labor during pregnancy and delivery, bringing many pains and dangers to mother and child. The main feature of submucosal fibroids is that the fibroids develop towards the mucosal surface and protrude into the uterine cavity, which can deform the uterine cavity and form a tip, stimulating the uterus to contract, which can discharge the tumor outside the uterus and hang in the vagina, while the tip remains in the body of the uterus, which is very likely to form uterine inversion, and some patients with fibroids affect their sexual life or sexual frigidity.
3.Clinical manifestations of uterine fibroids
(1) Vaginal bleeding: subplasmic fibroids often have no vaginal bleeding symptoms. Interfemoral fibroids may cause increased menstruation, often accompanied by heavy bleeding, prolonged menstrual period, some patients have menstruation for about 15 days or even longer, shortened cycle, and generally no irregular vaginal bleeding. In contrast, submucosal uterus has early symptoms and heavy symptoms, and irregular vaginal bleeding can occur when combined with infected ulcers and necrosis, causing great pain to patients.
(2) Compression symptoms: different symptoms are produced by the growth site and size of fibroids, for example, if the fibroids grow to the anterior wall of uterus with a diameter of about 8-10cm or larger, they can compress the bladder and produce urinary urgency, urinary frequency and even urinary retention, and if they grow in the posterior wall of uterus, they can cause the uterus to tilt and flex backwards (the cervix is displaced forward or grows inside the cervix), and produce constipation, broad stringing belt Myoma can compress the ureter, leading to ureteral and renal effusion, resulting in difficulty in urination.
(3) Abdominal mass: Most patients find a mass in the lower and middle abdomen in the morning before waking up when the bladder is full, which often leads to the discovery of uterine fibroids.
(4) Infertility: About 40% of patients with fibroids are infertile because the deformation of the uterine cavity prevents sperm from entering the fallopian tubes.
(5) Pain: Most of the patients do not suffer from pain, but acute abdominal pain can be caused by subplasmic myoma twisting, spasmodic pain can be caused by submucosal myoma stimulating contraction, and severe abdominal pain can be caused by red cystic change of myoma, often accompanied by gastrointestinal symptoms and elevated body temperature, and dysmenorrhea can be caused by combined endometriosis, and lumbosacral pain can be caused by some patients.
(6) Other symptoms: heavy menstrual flow, bleeding may be accompanied by secondary anemia, such as dizziness, weakness, palpitations. The leukorrhea may increase, and if there is infection, it may cause purulent leukorrhea to be excreted from the body.
4.Harm of uterine fibroids to human health
(1) Infertility or miscarriage: The presence of fibroids prevents the fertilized egg from being laid, resulting in infertility, and increases the chance of miscarriage after conception.
(2) Secondary anemia: Mostly seen in submucosal fibroids, menstruation can cause severe anemia secondary to hemorrhagic anemia.
(3) Compression symptoms: compression of the bladder may lead to frequent urination, urinary urgency or urinary retention; compression of the rectum may lead to constipation.
5.Treatment methods of uterine fibroids
(1) Surgical treatment: surgical removal of uterus or myoma excision. Some patients have to remove their uterus or ovaries and lose their physiological functions, which leads to a decrease in quality of life.
(2) Drug treatment: The use of female hormone suppressants such as androgens, mifepristone and GnRH-A can reduce the size of fibroids and restore normal menstruation. However, after discontinuation of the drug, the fibroids recur and increase in size, and menstruation reappears at a disrupted rate, which is unsatisfactory and unstable. In addition, long-term use of sex hormone inhibitors can produce menopausal symptoms such as hot flashes, impatience, amenorrhea, and osteoporosis.
(3) Interventional treatment: interventional embolization
6.Contraindications and indications for interventional treatment
Indications: Patients with all types of uterine fibroids.
Contraindications: serious liver and kidney dysfunction; serious cardiovascular disease; disorders of coagulation mechanism; allergy to contrast agents and anesthetics.
7.The treatment principle of interventional embolization
It is to embolize the blood supplying vessels of uterine fibroids and certain terminal vessels of normal uterine artery branches by pushing a certain size and quantity of embolization particles through catheter. (1) It can directly cut off the blood supply to the fibroids, which will lead to ischemia and necrosis, and gradually shrink to a smaller size, and improve the symptoms of compression caused by the occupancy of the 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 is gradually improved and restored.
8.Advantages of interventional treatment
(1) The uterine organs can be preserved intact.
(2) Less painful and faster recovery, requiring only 3 – 5 days of hospitalization.
(3) simpler and cheaper than traditional surgical treatment, without blood transfusion.
(4) Pregnancy rate of more than 90% after treatment
(5) A series of symptoms significantly improved or disappeared after treatment.
(6) No damage to the reproductive organs, delaying aging.
(7) No recurrence has been followed up for 8 years abroad after interventional treatment and continues to be followed up.
9.The reaction and treatment after interventional treatment
(1) Ischemic pain: 88.66% of patients will have varying degrees of lower abdominal distension and cramping pain after treatment, with varying duration, from 5-6 hours on the short side to 3 days on the long side, which can be relieved by giving diclofenac anal suppositories.
(2) Fever: 25% of patients, especially those with larger myomas, may develop hypothermia of about 38°C within a week after embolization. Usually no 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 endometrial growth after embolization.
10.Efficacy evaluation
(1) Menstrual changes: According to the reports and our observation, the most significant clinical effect after uterine artery embolization therapy is that it can significantly reduce the menstrual flow in patients with uterine fibroids. Almost all patients showed a significant reduction in menstrual volume after surgery, and the more menstrual the patient had before surgery, the more significant the reduction was. The menstrual cycle and period can return to normal soon.
(2) Improvement of anemia: Among the patients with uterine fibroids treated with arterial embolization in our hospital, about 37% of them had different degrees of anemia combined before surgery, and the average hemoglobin amount was 79.45g/L, with obvious clinical manifestations of dizziness, weakness and panic discomfort, and the average hemoglobin amount of patients six months after surgery was 104.85g/L, which increased by 31.98%. And the lower the preoperative hemoglobin, the higher the postoperative rise, with a clinical symptom relief rate of over 90%.
(3) Changes in uterus and fibroids: Among the patients with fibroids treated with arterial embolization in our hospital, the largest uterus was 11.7×7.8×9.7 cm3 before treatment, the total average volume of uterus was 551.66 cm3, and the total average volume of fibroids was 108.96 cm3; six months after treatment, the total average volume of uterus was 271.81 cm3, which was 50.73% smaller than that before treatment The total average volume of the fibroids was 47.58 cm3, which was 56.33% smaller than that before treatment. One year later, the total average volume of myoma was 33.91 cm3, which was 63.81% smaller than that before treatment.
(4) Relief of pelvic compression symptoms and lower abdominal pain: In patients with myoma treated with uterine artery embolization in our hospital, those with pelvic compression symptoms such as frequent urination, urinary retention or constipation before the operation were significantly relieved or disappeared after the operation. The symptoms of lower abdominal pain were also significantly relieved or disappeared.