Myoma ofuterus, also known as smooth muscle tumor of the uterus, is the most common type of benign tumor of the female genitalia. It is estimated that one in every four or five women over the age of 35 has fibroids. Many patients with uterine fibroids are asymptomatic and are found during screening, and are divided into three main categories depending on the location of the fibroids in the uterus, the third of which is submucosal fibroids. The third category is submucosal fibroids, which include fibroids inside the uterine cavity or protruding from the ectocervix. Submucosal fibroids are divided into submucosal fibroids type O, type I, and type II according to the relationship between the fibroids and the uterine wall in the uterine cavity. type 0: submucosal fibroids with tissues and no myometrial extension; type I: no tissues and less than 50% extension to the myometrium; type II: no tissues and more than 50% extension to the myometrium.
The cause of fibroids may be related to the high estrogen level in the body and the proliferation of smooth muscle cells in the uterus caused by long-term estrogen stimulation, whether the fibroids will grow in the body or the physical relationship, that is, the genes in the body determine whether the fibroids will be born.
1, age: benign tumors mostly occur in women at the reproductive stage, malignant tumors mostly occur in older women, and a few special types of tumors occur in adolescent and young women.
2.Childbirth: The factors related to childbirth such as premature delivery, close delivery and multiple delivery, in addition to the increase of estrogen level during pregnancy, the fibroids will become bigger quickly.
3, endocrine: many women take estrogen-containing drugs, supplements and some beauty products privately without doctor’s guidance, which deliberately or unknowingly increases the estrogen level in the body.
4. Bad lifestyle: smoking, especially heavy smoking, drinking and long-term intake of high-fat food.
Symptoms 1, secondary anemia: If the patient has prolonged excessive menstruation can lead to secondary anemia, general weakness, pallor, shortness of breath, panic and other symptoms of submucosal fibroids.
2.Menstrual change: It is the most common symptom of submucosal uterine fibroids, manifested as shortened menstrual cycle, increased menstrual volume, prolonged menstrual period, irregular vaginal bleeding, etc.
3.Increased leucorrhea: When submucosal fibroids become ulcerated, infected, bleeding or necrotic, it will produce bloody leucorrhea or pus smelly leucorrhea, and the amount can be a lot.
4. Infertility: submucosal fibroids can cause infertility or miscarriage when the fibroids compress the opening of fallopian tubes or deform the uterine cavity so as to prevent the fertilized egg from being laid.
Ultrasound examination is the most convenient and non-invasive method used in clinical practice. At present, ultrasound examination is more common in China. Ultrasound examination not only helps to diagnose fibroids and differentiate whether they are degenerative or malignant, but also helps to differentiate endometrial polyps and endometrial cancer.
Interstitial fibroids or submucosal fibroids often enlarge and deform the uterine cavity, so a uterine probe can be used to detect the size and direction of the uterine cavity. However, it is important to note that the uterine cavity is often tortuous and curved, or obstructed by submucosal fibroids, so that the probe cannot be fully explored.
In the case of calcified fibroids, they appear as scattered consistent spots, or shell-like calcified envelopes, or rough and wavy honeycomb-like edges.
Diagnostic scraping Small submucosal fibroids or dysfunctional uterine bleeding, endometrial polyps are not easily detected by double diagnosis, so scraping can be used to assist the diagnosis. In case of submucosal fibroids, the scraping spoon may feel a raised surface in the uterine cavity, start to rise high and then slide low, or feel something sliding in the uterine cavity. However, scraping may cause bleeding, infection, necrosis, or even sepsis, and should be performed strictly aseptically and gently, and the scraped material should be sent for pathological examination. If submucosal myoma is suspected and the diagnosis and scraping is still not clear, hysterosalpingography can be used.
The ideal hysterosalpingogram can not only show the number and size of submucosal fibroids, but also can be localized. Therefore, it is very helpful for the early diagnosis of submucosal fibroids and the method is simple. CT and MRI are generally not needed for these two tests.
CT diagnosis of leiomyosarcoma has images that express only the details within a specific level, and the image structures do not overlap each other. CT images of benign uterine tumors are enlarged in size, uniform in structure, and +40 to +60H in density (+40 to +50H in normal uterus MRI diagnoses leiomyosarcoma with different signals for the presence or absence of degeneration within the leiomyosarcoma, its type and its degree. If there is no degeneration or mild degeneration in the nucleus, the internal signal is more homogeneous. Conversely, those with significant degeneration show different signals.
The diagnosis of submucosal leiomyoma is clear by ultrasound and routine blood tests 1.
Submucosal fibroids can sometimes open the uterine orifice wide and the lower end of the fibroid can be palpated through the uterine orifice; if the fibroid is hanging in the vagina, the body of the fibroid can be seen and its tip can be palpated.
B-type ultrasound can show the size and location of fibroids more clearly; it is one of the main means to diagnose fibroids; diagnostic scraping can feel the protrusion or obvious unevenness of the endometrium, through the above examinations, there is no difficulty in diagnosis. If the fibroids are growing rapidly or continue to increase in size even after menopause, the possibility of malignant transformation should be considered.
Nowadays, hysteroscopic resection of submucosal fibroids and intramural fibroids has been developed as a mature procedure in gynecology. Compared to hysterectomy and transabdominal resection, hysteroscopic removal of submucosal fibroids has many advantages, firstly, it is not open, which significantly shortens the postoperative recovery time, and small fibroids can be performed on an outpatient basis; secondly, there is no incision in the uterus, which greatly reduces the chance of future cesarean delivery; and finally, the prognosis of the operation is comparable to that of traditional open surgery. Especially for patients with submucosal fibroids who have never had children, pregnancy can be achieved two to three months after hysteroscopy. This greatly reduces the time required for postoperative contraception compared to traditional surgery.