Patient: The uterus is enlarged and a 7.1*5.7 cm weakly echogenic mass is detected in the anterior wall, with clear borders and uneven internal echogenicity. I would like to know if this is a suitable case for interventional surgery. I also saw that there is a bulge at the surgical site after the intervention, I wonder if this is common. I’m a little worried that the surgery will be painful and I’m afraid of the bulge. Lu Wei: The leiomyosarcoma may be a subplasma leiomyosarcoma. Most of the broad-based subplasma can be treated with intervention, but if it is a leiomyosarcoma with an outward protrusion, it is not an indication for intervention. You need to see the pictures to know. I’m not sure where the bulge is, but is it the puncture site at the base of the thigh? If this is the place, it may be a local hematoma, which is related to improper compression and hemostasis at that time, but it does not usually happen, and even if it happens, it can be absorbed on its own, and rarely a pseudoaneurysm appears. A few patients have mild lower abdominal discomfort and less pain during surgery, compared to surgery which is definitely more painful and has more complications. Lu Wei: Interventional treatment is less painful for a few patients with mild lower abdominal discomfort, compared to surgery, which is definitely more painful and has more complications. Patient: I’ve had three ultrasounds without pointing out which kind of myoma it is. I read your reply for other patients a few days ago, and it said that the outward protrusion is not suitable for intervention, so I’m a little worried. Dr. Lu, what would you say is the best way to reduce a fibroid as large as mine after intervention (I know there are individual differences)? Is it possible that multiple fibroids can be operated like single ones without embolizing multiple points? Lu Wei: Leiomyosarcoma with outward protrusion of the tip is often not very large, and your case is probably a broad-based myoma. The main reason is that after the intervention, the fibroid may fall off and separate from the uterus, so it may be free in the pelvic cavity, which requires surgery to remove it. Generally, after embolization, the fibroids shrink by 70% on average, and some of them may disappear, and 90% of the clinical symptoms are relieved. Multiple fibroids can be treated with simultaneous embolization, and multiple treatments are not necessary. My article “Uterine fibroids can cause infertility” is accompanied by a picture showing the myoma protruding outward with the tip. Lu Wei: The incidence of hematoma at the puncture site is 1-2%. Patient: I recently read some information about interventions, and one of them said that interventions are best for symptomatic ones, and open surgery is still recommended for asymptomatic ones. I don’t have abdominal pain, my menstrual flow is not too much, I had low menstrual flow for a while, and I have bowel movement every day, but I have a little difficulty in defecating. Lu Wei: In fact, the presence or absence of symptoms is a condition for choosing to treat or not to treat, and has nothing to do with the choice of treatment. You can choose to observe without treatment first, because you feel that it does not affect your daily life much. If you choose to treat, then the more asymptomatic you are, the more you should choose less invasive treatment, because interventional treatment can also preserve the uterus and fertility, and take a step back, even if the interventional treatment does not work well, it does not affect the surgery. Your fibroid is 7.1 x 5.7 cm, which may compress the bladder more in the anterior wall, but because it grows slowly, it slowly adapts so the effect is not obvious. The fibroids may produce frequent urination, lower abdominal swelling, difficulty in bowel movement, menstrual leucorrhea, etc., as if you were pregnant. You don’t feel anything when the child is small, but you definitely have back pain, abdominal swelling and frequent urination when the fetus is big. Your case is suitable for interventional treatment! Patient: 7.1×5.7cm Can I be observed again? I found out in February this year, at that time 6.0×5.0cm, the doctor suggested observation, in August, it was 6.7×6.2×5.4cm, I changed two doctors to consult the result, they all suggested open surgery immediately, the attitude and tone was very strong, but because I really did not have time at that time, so I delayed for another two months, when I went to check at the end of October, it was 7.1×5.7cm, during this period I have been looking for trauma Some people suggested laparoscopy, but they all said it was too big, so I was determined to have open surgery. How many days will it take from the day I start the surgery until I can go to work? Patient: At my age, can’t I wait until my menstruation stops and the fibroids shrink on their own, and is my fibroids growing fast? Lu Wei: It is possible to observe it, but you are still young, and you have about 8-10 years left in menopause. According to the size change above, the fibroid should still be growing, and the growth rate is not too slow. The best advice is not to exceed 8cm. Patient: Dr. Lu, after communicating with you a few days ago, I made up my mind to go for intervention, so I went to the hospital on December 12 to consult with the doctor in the intervention department, because I had not done ultrasound in their hospital, so the doctor asked me to do an ultrasound to confirm which kind of myoma it was. The doctor also said that I can have my fibroid removed by surgery even if I have a single fibroid, which means that it is not suitable for intervention anymore. Is it true that if I remove the fibroids this time and if they grow again in the future, can I still use interventional treatment? And what should I do in my current situation? Lu Wei: If the subplasma myoma is protruding outward with the tip, I suggest you to have surgery because this kind of myoma may fall off after intervention. Your fibroid does not look like a leiomyosarcoma with a tip, and there are multiple fibroids, so I would recommend you to have an intervention. Because it is likely that other fibroids will still need treatment after surgery. But it is better to exclude endometrium and other lesions. Patient: I have had ultrasound at three hospitals, and one of them said there were signs of multiple fibroids, but the report was only for this one fibroid. If I take this time to remove the fibroid, can I still use interventional treatment if it grows elsewhere in the future? Lu Wei: Interventional treatment is available for fibroids that recur after surgery, don’t worry about that.