What is uterine fibroids?
Uterine fibroids, known as the “first tumor of obstetrics and gynecology”, are the most common gynecological tumors in women of childbearing age, and the incidence of uterine fibroids in women over 30 years old is as high as 20% – 30%. Since uterine fibroids are mainly made by the proliferation of uterine smooth muscle cells, with a small amount of fibrous connective tissue existing as a supporting tissue, it is more accurate to call them uterine smooth muscle tumors. The abbreviation is uterine fibroids. The common symptoms are frequent menstruation, excessive menstruation and prolonged menstruation, which increase the incidence of anemia and decrease the physical fitness of patients, and seriously affect the health of patients.
Second, the causes of fibroids
The cause of uterine fibroids is still not well understood, and may involve a complex interaction between cellular mutations in the normal muscle layer, sex hormones and local growth factors. According to a large number of clinical observations and experimental results, uterine fibroids are hormone-dependent tumors, and estrogen is the main factor contributing to the growth of fibroids, and it is speculated that human placental prolactin (HPL) can also synergize with the mitogenic effect of estrogen, and it is believed that the accelerated growth of uterine fibroids during pregnancy is related to the high hormonal environment during pregnancy, and HPL may also participate in the role.
What are the symptoms of fibroids in patients with uterine fibroids?
Most patients are asymptomatic and are only occasionally detected during pelvic examination or ultrasonography. If there are symptoms, they are closely related to the growth site, speed, degeneration and complications of fibroids, but less related to the size and number of fibroids. Those with multiple subplasma myomas may not be symptomatic, while a small submucosal myoma can often cause irregular vaginal bleeding or excessive menstruation.
Common clinical symptoms include.
(1) Uterine bleeding is the most predominant symptom of fibroids and occurs in more than half of patients. The most common symptoms are cyclic bleeding, which can be manifested as increased menstrual flow, prolonged periods or shortened cycles. It may also manifest as irregular vaginal bleeding without a menstrual cycle. Uterine bleeding is more common with submucosal and interstitial myomas, while subplasmalemma rarely causes uterine bleeding.
(2) Abdominal mass and pressure symptoms of myoma gradually grow, when it makes the uterus enlarge more than the size of the uterus in 3 months of pregnancy or is a large subplasma myoma located at the bottom of the uterus, a mass can often be found in the abdomen, more obvious in the early morning when the bladder is full. The mass is solid, movable and painless. When the fibroid grows to a certain size, it can cause symptoms of pressure on the surrounding organs. Anterior wall fibroids close to the bladder can cause frequent and urgent urination; huge cervical fibroids compressing the bladder can cause dyspareunia or even urinary retention; posterior wall fibroids, especially those in the isthmus or posterior lip of the cervix, can compress the rectum, causing dyspareunia and discomfort after defecation; huge broad ligament fibroids can compress the ureter and even cause hydronephrosis.
(3) Pain Generally, fibroids do not cause pain, but many patients may complain of lower abdominal cramping and back pain. Acute abdominal pain can occur when subplasma fibroids are twisted or when red degeneration of fibroids occurs, and it is not uncommon for fibroids to be combined with endometriosis or adenomyosis, which can cause dysmenorrhea.
(4) Increased leucorrhea is caused by the enlargement of the uterine cavity, the increase of endometrial glands and the pelvic congestion. If the submucosal fibroids of the uterus or cervix become ulcerated, infected or necrotic, bloody or purulent leucorrhea may be produced.
(5) Infertility and miscarriage Some patients with uterine fibroids are infertile or prone to miscarriage. The effect on conception and pregnancy outcome may be related to the growth site, size and number of fibroids. Large fibroids may cause deformation of the uterine cavity, preventing the implantation of the gestational sac and the growth of the embryo; fibroids compressing the fallopian tubes may lead to dysfunctional lumen; submucosal fibroids may prevent the implantation of the gestational sac or affect the entry of sperm into the uterine cavity. The rate of spontaneous abortion is higher in patients with leiomyoma than in the normal population, with a ratio of about 4:1.
(6) Anemia can be caused by prolonged excessive menstruation or irregular vaginal bleeding, and more serious anemia is seen in patients with submucosal fibroids.
(7) Other rare patients with uterine fibroids can develop erythrocytosis and hypoglycemia, which are generally thought to be related to the production of ectopic hormones by the tumor. Uterine fibroids smaller than 5cm or without symptoms can be observed without treatment, but once symptoms such as excessive menstrual flow, anemia, pressure and discomfort, affecting conception, etc. appear, early treatment is recommended.
What is minimally invasive interventional treatment for fibroids?
In the past, uterine fibroids were mainly removed surgically, but young patients are eager to preserve the function of the uterus and improve the quality of life. Now with a new interventional treatment method DD uterine artery embolization (UAE) to treat fibroids, patients can eliminate tumors and lesions without surgery and avoid the pain of uterine removal, making the dream of doctors and patients to treat fibroids for years to preserve the uterus a reality. Compared with patients with fibroids treated with surgery, women treated with uterine artery embolization have shorter hospital stays, less trauma, faster recovery, fewer complications, better outcomes, preservation of uterine function and normal fertility, and no interference with other treatments after treatment.
Uterine fibroids have been treated with interventional therapy for more than 10 years. In 1990, Ravina, a French medical doctor, first started to study the therapeutic effect of uterine artery embolization (UAE) on uterine fibroids and found that the fibroids shrank significantly after UAE treatment. With an average follow-up of 20 months, the uterine fibroids decreased in size by 20% – 80%, which firstly proposed a new method of UAE treatment for uterine fibroids. After that, Goodwin in the United States and Bradley in the United Kingdom have used UAE to treat uterine fibroids and achieved promising results. In 1997 and 1998, a larger number of cases were reported in Ravina, where UAE was successfully performed on patients with symptomatic fibroids and patients with recurrence of fibroids after myomectomy. This led to widespread interest among medical practitioners in various countries and was considered an alternative treatment for uterine fibroids to hysterectomy, which could reduce excessive menstruation caused by fibroids, relieve anemia, reduce the size of the uterus and fibroids, and achieve the goal of replacing surgery. 2000 Ravina et al. observed in 286 patients with uterine fibroids treated with UAE, and of the 262 cases available for evaluation 245 clinical symptoms disappeared and within 6 months of follow-up, fibroids shrank by 60%, menstruation returned to normal in 80% of patients and there were 13 pregnancies, no cases of recurrence, and few complications. Therefore, UAE is considered an independent and new minimally invasive treatment for uterine fibroids, and fibroids of different sizes respond well to the intervention, and it is clearly observed pathologically that the larger the fibroid, the better the response.
UAE is a new minimally invasive treatment for uterine fibroids that preserves uterine function and normal fertility, replaces hysterectomy and myomectomy in young patients, preserves the integrity of the uterus, is more in line with human biology, and converts the treatment of disease from organ-destructive to organ-protective surgery.
The application of interventional therapy to the conservative treatment of uterine fibroids is a major event in interventional radiology and obstetrics and gynecology, and also a milestone in the conservative treatment of uterine fibroids.
V. How is minimally invasive interventional treatment for uterine fibroids performed?
The procedure of interventional treatment for uterine fibroids is as follows: the femoral artery is touched at 0.5 cm below the midpoint of inguinal ligament as the puncture point, and the puncture enters the arterial system of human body. -The uterine artery is inserted through the catheter, and a certain size and amount of embolic particles are inserted to embolize the blood vessels supplying the fibroids and certain peripheral vessels of the normal uterine artery branches.
A diagram of the interventional model for uterine fibroids, in which the catheter selectively enters the blood supplying artery of the fibroid and then embolizes it
In vitro magnification of the PVA microspheres we selected for embolization and their embolic response under microscopy. Compared with conventional embolization particles, the microspheres are more likely to enter the vascular end of the fibroids, and the efficacy is more complete and durable.
VI. What is the principle of minimally invasive interventional treatment for uterine fibroids?
The treatment principle of interventional embolization of uterine fibroids.
(1) It can directly cut off the blood supply of fibroids, which will lead to ischemia and necrosis of the tumor, gradually shrink and become smaller, and improve the compression symptoms caused by the occupancy of 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.
VII. What is the efficacy of minimally invasive interventional treatment for uterine fibroids?
Several large foreign studies have shown that in the short and medium-term follow-up observation (5–14 months) of patients after uterine artery embolization, the symptom scores of anemia, pressure, pain, etc. will have a very significant decrease, while the life state scores of physical strength, mood, self-awareness and sexual function will be significantly higher than before the operation, all reaching or approaching 100 points All of them are at or near 100. Compared to conventional gynecologic resection, there is no significant difference in long-term symptom improvement and life status scores, but patients who undergo uterine artery embolization recover more quickly from postoperative pain and other discomfort, have shorter hospital stays, and return to family, society, and work sooner. The vast majority of fibroids (more than 90%) will shrink significantly in size in about 6 months and remain there.
How is the safety of interventional treatment for fibroids?
Interventional treatment for uterine fibroids causes very little harm to the human body because of minimal trauma, no wound and no bleeding. A common concern is whether it will affect ovarian function causing premature aging. According to foreign literature, there is no significant difference in hormone levels after myomectomy and hysterectomy and myoma removal. Another concern is whether uterine fibroid embolization affects pregnancy, and this is a clear conclusion: that is, uterine fibroid embolization does not affect pregnancy. In one case, the embolization of fibroids was done without the knowledge of pregnancy, but a healthy baby was delivered at full term. Therefore, embolization of fibroids is a very safe treatment. The incidence and severity of postoperative complications are much lower than those of traditional treatments such as hysterectomy and myomectomy.
What are the contraindications and indications for interventional treatment of uterine fibroids?
1, contraindications.
(1) severe liver and kidney dysfunction.
(2) serious cardiovascular disease.
(3) serious disorders of coagulation mechanism.
(4) Allergy to contrast agents and anesthetics.
(5) Uterine fibroids with malignant tendency.
2. Indications.
(1) Symptomatic uterine fibroids or asymptomatic but with a tumor diameter of 5 cm or more.
(2) Patients with uterine fibroids who are unwilling to undergo surgical treatment.
(3) patients with uterine fibroids combined with heart disease, diabetes and other hysterectomy risks.
X. What are the advantages of interventional treatment for uterine fibroids?
Uterine artery embolization therapy has shown great potential and unique advantages in the treatment of symptomatic fibroids.
The biggest advantage is that it can preserve uterine functions, such as normal menstruation, pregnancy and delivery, and does not affect conception; it avoids the traumatic blows of surgery and a series of postoperative complications, and its effect on symptom improvement is comparable to that of surgery.
2. It is easy for patients to accept because of the small trauma, quick recovery and short hospitalization time.
3. It is easier and more economical than traditional surgical treatment and saves money. Blood transfusion is generally not needed.
Finally, the advantage of this treatment is that it leaves a lot of room for you, even if the embolization fails, you can still apply surgery and medication and other means.
XI. What are the postoperative reactions after interventional treatment of uterine fibroids? How to deal with them?
Minimally invasive interventional treatment for uterine fibroids, because of minimal trauma and no need for anesthesia, generally has no particularly serious adverse reactions during and after surgery, and the following reactions may occur.
1. Ischemic pain.
It is the most common adverse reaction. 88.66% of patients will have different 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 analgesic symptomatic treatment. Patients who are more sensitive to pain are recommended to embed analgesic pumps before surgery, which can significantly reduce the pain.
2. Fever.
25% of patients, especially those with larger myomas, can have a low fever of about 38°C within a week after embolization. Generally, no special treatment is needed, and it will subside on its own after a week.
3.Soreness and weakness of lower limbs.
After embolization, 60% of patients feel soreness and weakness of both lower limbs, 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.
5. Transvaginal prolapse of myoma.
It is seen in patients with submucosal fibroids, which can be discharged from the vagina after shedding after ischemia. If the fibroids are large enough to block the vaginal opening, they can be removed vaginally by visiting the obstetrics and gynecology department, and the complete treatment of fibroids can be achieved by discharging the fibroids from the vagina.
12.What other diseases can be treated by uterine artery embolization besides fibroids?
Another common disease in women of childbearing age, myometriosis, can also be treated by the minimally invasive interventional method of uterine artery embolization. The greatest pain caused by myometriosis is the unbearable and severe menstrual pain, which is significantly reduced by the next menstrual period after treatment. Other treatment methods, such as medication with too many side effects and surgery requiring complete removal of the uterus, are not very suitable for young and middle-aged female patients.
Likewise postpartum hemorrhage, placental implantation, ectopic pregnancy, scar pregnancy and other gynecological emergencies can be treated by uterine artery embolization for the purpose of preserving the uterus, treating the disease and saving lives.