Uterine fibroids are the most common benign tumors of the female reproductive organs, with an incidence of 20%-30%. More and more women are paying more attention to the physiological function of the uterus and the integrity of the body, and more and more patients are asking for preservation of the uterus. So far, there is a lack of safe and effective non-surgical treatment methods with low recurrence rate, so uterine fibroids are still mainly treated surgically. For patients who require preservation of the integrity of the uterus and fertility, myomectomy is currently the best treatment method. Minimally invasive surgery, and laparoscopic and hysteroscopic surgery are the best options.
Do all fibroids require surgery? Uterine fibroids should be considered for surgical treatment.
1, excessive menstruation with anemia, pain or difficulty in urination caused by myoma compression.
2, fibroid uterus exceeding the size of 3 months of pregnancy.
3, myoma grows rapidly and has the possibility of malignant transformation.
4, submucosal leiomyoma, especially if it has prolapsed into the cervical os.
5, complications of leiomyoma, such as torsion of the tip and infection.
6, young infertile patients with leiomyoma.
7, those whose diagnosis is unknown and cannot be distinguished from ovarian tumors.
The malignancy rate of uterine fibroids is only 0.5%-1%, so it is worthwhile for gynecologists to pay attention to whether surgery is needed and whether there are indications for surgery.
Laparoscopic myomectomy
In the past 20 years, with the continuous improvement of laparoscopic surgical instruments and suturing techniques, laparoscopic myomectomy is gradually becoming an alternative surgical method to transabdominal surgery.
The outstanding advantages of laparoscopic hysterectomy are
(1) small abdominal wound, less intestinal disturbance, light postoperative wound pain, short hospital stay and rapid recovery.
(2) Clear surgical field of view with magnification, allowing comprehensive observation of pelvic and abdominal organ lesions.
(3) It can safely perform the decomposition of pelvic adhesions and the simultaneous treatment of tubo-ovarian diseases.
Specific indications for laparoscopic myomectomy.
(1) subplasmalemma or broad ligament uterine fibroids.
2, interstitial myometrium of less than 3-4 medium size (within 6 cm).
3, single interstitial fibroids of 7-10 cm in diameter.
Laparoscopic uterine artery coagulation (LUC) has been proposed in Taiwan for the treatment of uterine fibroids, and its treatment mechanism is similar to that of uterine artery embolization. Compared with uterine artery embolization, laparoscopic uterine artery coagulation has the advantages of avoiding complications such as inguinal hematoma, misembolization of other pelvic vessels, temporary or persistent ovarian failure, and radiation exposure; it is also less painful and less expensive after surgery; and it can be performed by a gynecologist.
Transvaginal myomectomy
Transvaginal myomectomy (TVM) also has its distinct advantages.
1. no scarring of the abdomen, little abdominal interference, mild postoperative pain and quick recovery.
2, no equipment requirements and low medical costs. However, there are some disadvantages of the negative surgery, such as limited operating space and difficulty in treating adnexa at the same time. It is particularly suitable for patients with uterine prolapse and vaginal wall bulge.
The more acceptable indications for transvaginal myomectomy (TVM), due to the limited space available for the operation of the femoral procedure, are
1, no more than 2 (preferably single) anterior and posterior wall near the lower uterine segment or intermyometrial fibroids <7 cm in diameter.
2, subplasmalemmal fibroids.
3, cervical fibroids. It is also required to have a loose vagina, no pelvic adhesions and good uterine mobility.
Hysteroscopic myomectomy
At present, hysteroscopic myomectomy has become the treatment of choice for submucosal fibroids.
The currently more accepted indications for hysteroscopic treatment of myoma are
Uterus ≤ 6 weeks, fibroids ≤ 3 cm in diameter and predominantly protruding into the uterine cavity. The determining factor for hysteroscopic surgery is the depth of the myoma within the myometrium. Hysteroscopic resection is difficult in cases larger than 3 cm and where the fibroid is located in >50% of the myometrium, and multiple surgical procedures are required if a single resection is not possible. To prevent uterine perforation, it is usually performed under laparoscopic supervision.
V. Open myomectomy
Open myomectomy has the broadest indications and is suitable for all young patients with fibroids who wish to have children and have indications for surgery. It is not limited by the location, size and number of fibroids, so difficult myomectomy procedures that are difficult to perform by minimally invasive routes are indicated for open myomectomy.
Direct open myomectomy is generally indicated for the following conditions.
1.Special areas of fibroids (e.g. fibroids close to the mucosa);
2. multiple fibroids (more than 5) with uterine volume greater than 12 weeks of gestation
3, and fibroids that recur after resection by various routes.
4, combined with endometriosis and other suspected heavy pelvic adhesions.
In conclusion, as a common benign lesion, fibroids have a wide impact on women’s health, and clinicians cannot simply you implement hysterectomy to solve the problem once and for all. Women, whether they are fertile or not, have a uterus that is an important organ for their dignity and well-being.
Therefore, clinicians need to continue to seek more effective, minimally invasive, and inexpensive treatment methods to eliminate the disease, preserve the uterus, and maintain a woman’s complete dignity. The choice of surgical method for uterine fibroids should be based on the patient’s personal situation, the operator’s skills and experience, and the equipment conditions of the medical unit where the patient is located.