The etiology of uterine fibroids: The understanding of the etiology of uterine fibroids is still relatively superficial; local hormonal imbalance may be part of the etiology, but it is not well understood. However, it is clear that fibroids are a hormone-dependent disease, and usually, if menopause occurs, fibroids will also shrink as hormone levels decline. The surgical approach to fibroids can be performed openly, laparoscopically, through a hysteroscope or through a cathodic procedure if fibroid removal is being considered. Open surgery is the traditional surgical procedure, usually performed in the lower abdomen for about 10 cm (depending on the location and size of the fibroids), and is suitable for almost all fibroids, but it is relatively more invasive and slower to recover. Laparoscopic technique is a surgical method that has become popular in the last 20 years. It is a surgical method to remove fibroids through 3-4 incisions of 0.5-2 cm in diameter on the abdominal wall and through surgical instruments, which has gained popularity among patients because of the small scars on the abdominal wall and fast recovery after surgery. Some people may ask, how to take out the fibroids when they are so big? Don’t worry, there is now an instrument called myoma crusher which can crush the fibroids and remove them from the small hole. Laparoscopic surgery has become a major treatment modality for uterine fibroids and has gained popularity among patients because of its light pain and quick recovery after surgery. However, the procedure requires high surgical skills of physicians and hospital equipment, so not every hospital can perform this procedure. Not all fibroids can be removed laparoscopically, so what kind of fibroids are suitable for laparoscopic surgery? If there are too many fibroids, the laparoscopic surgery will not be able to reach the small ones due to the lack of touch, so there is a risk of missing them or making the surgery difficult due to too many fibroids. Therefore, at this time, I believe that if the preoperative ultrasound indicates more than 5 fibroids, then laparoscopic surgery should not be insisted upon. In addition, if the fibroids are too large, for example, more than 10 cm, then bleeding during surgery and difficulty in suturing are not considered preferable to laparoscopic surgery, and open surgery should be considered more appropriate. If a patient has a myoma larger than 10 cm and wants to insist on laparoscopic surgery, preoperative application of some drugs to reduce the size of the myoma in order to obtain laparoscopic surgery for the myoma can also be considered, but it is expensive (each GnRH-a injection costs about 2000 RMB and requires 1-2 injections). Hysteroscopic surgery is mainly suitable for fibroids located inside the uterine cavity. Hysteroscopic removal of fibroids requires special equipment and the skill of the surgeon, so it is also a hospital and physician-dependent procedure; negative surgery has two meanings, one is for certain submucosal fibroids, which can be removed completely from the vagina by the vaginal route if the fibroids are completely prolapsed from the uterine cavity into the vagina, and the other negative myomectomy is for This procedure requires a high level of surgical skill. In addition, since the fibroids are incised from the posterior vault, there are special requirements for the size, number and location of the fibroids, which are generally suitable for fibroids with a diameter of 7 cm, no more than 2 fibroids, and fibroids close to the bottom. If the patient is a candidate for a vaginal procedure, the postoperative pain is less (there are no sensitive painful nerves in the vagina so the pain is less severe), but the risk of postoperative infection is slightly higher because the vagina is a bacterial environment. When should I have fibroids treated? Not everyone with fibroids needs surgery. According to studies, 10% of women in the population have fibroids, but most are asymptomatic. What kind of fibroids need to be treated surgically? First of all, surgery is needed if the fibroids produce some symptoms. The main symptoms may include excessive menstrual flow, secondary anemia, pressure on the bladder resulting in frequent urination, or pressure on the rectum resulting in constipation or difficulty in defecation. Once symptoms are present, they will need to be treated. If the fibroids are too large, for example, if the uterus is found to be the size of a 12-week pregnancy, surgery should be considered. In addition, if a fibroid is suspected to be malignant, surgery should be considered to rule out the possibility of malignancy. For young women who have not had children, there is no unified understanding of how large a fibroid should be considered for surgery if they have the desire to have children, some people think it is necessary to operate if it is more than 4 cm, others think it is necessary to operate if it is more than 7 cm, but it is not necessary to deal with small fibroids. The main concern during pregnancy is the red degeneration that occurs during pregnancy and causes pain and miscarriage during pregnancy, but the chances are small and there are many people who can have a pregnancy with a tumor. The fibroids may grow in size during pregnancy. If there is no need to have children, small asymptomatic fibroids may not need to be treated at all, as they have little chance of becoming malignant. My opinion is that surgery should not be done because of the risk of surgery and because after myomectomy, more serious adhesions often occur, such as adhesions to the bladder, intestines and pelvic wall, which may or may not produce symptoms of abdominal pain, but have a greater impact on secondary surgery. laparoscopic surgery to manage them. Therefore, if it is possible not to perform surgery, do not do it, and if surgery is necessary, it is possible to solve the problem in a single operation if possible. New treatment methods have emerged in recent years, including focused ultrasound for fibroids and arterial embolization for fibroids. The principle of focused ultrasound is similar to solar foci, by gathering ultrasound energy to a focal point, the local temperature of the focal point rises to more than 80℃, which plays the purpose of ablating fibroids. The company, domestic technology in this area of equipment manufacturing has been quite mature, not inferior to the Israeli technology. From the observation of the current clinical treatment effect, the size of fibroids can be significantly reduced after 3 months of treatment, the volume can be shrunk by more than 50%, and for symptomatic fibroids, symptom relief can also be obtained, the whole treatment process can be completed in the outpatient clinic, the Israeli company is under the monitoring of MRI, while the equipment of Hefu company is currently completed under the monitoring of ultrasound, because it is gathered The skin is not damaged and there is no scarring, which is less invasive. The principle of arterial embolization is to insert an arterial catheter into the artery of the patient’s uterus, and then block the blood supplying artery with some embolic agent, and the fibroid will shrink after lack of blood supply. Both methods preserve the uterus, but the long-term results need to be further evaluated because of the inherent risk of recurrence of fibroids. Studies abroad suggest that 20% of patients require secondary surgical management 2 years after surgery. Therefore, such conservative treatments must be viewed objectively, are not suitable for all patients, and are not a foolproof technique. In addition, both approaches should not be considered as the first choice of treatment if there is a suspicion of malignancy because of the lack of pathological results obtained. What type of surgery should be performed Regardless of the route through which the surgery is performed (open, laparoscopic or cathartic), there are two types of surgery for uterine fibroids, a myomectomy that removes the fibroids leaving the uterus behind, and another surgery that removes the uterus, both with different indications. The uterus has two roles, one is to give birth to children and the other is to have menstruation. The uterus has nothing to do with aging, and the estrogen and progesterone in the body are secreted by the ovaries. The choice of the surgical procedure depends mainly on the patient’s age and fertility requirements. For young women with fertility requirements, myomectomy is usually performed, while for patients who are close to menopause without fertility requirements, hysterectomy should generally be the appropriate choice. In outpatient clinics, we encounter many near-menopausal patients who strongly request preservation of the uterus. Although this is technically possible, as a physician, we generally do not recommend such a procedure at the risk of recurrence and the difficulty of secondary surgery. Such patients can be considered if they are willing to try the new treatment of aggregated ultrasound or arterial embolization, but any procedure that preserves the uterus is at risk of recurrence. According to statistics from Peking Union Medical College Hospital, the 5-year recurrence rate after single myoma resection is 15%, and the 5-year recurrence rate for multiple myomas is 30%. Is there a possibility of malignant transformation? The chance of malignancy of fibroids is low, about 0.5%. Symptoms of malignant fibroids include: ① recent increase of fibroids; ② ultrasound indicates rich blood flow; ③ elevated blood LDH. Is there any way to prevent fibroids? So far, there are no medications to prevent or treat fibroids. Some medications, such as GnRH-a and progesterone, can reduce the size of fibroids before surgery to facilitate surgery, but they will increase after stopping the medication, so conventional treatment is not recommended.