Interventional treatment of uterine fibroids and adenomyosis

  Uterine fibroids, which are hormone-dependent diseases, mainly composed of smooth muscle and connective tissue, are the most common benign tumors in female reproductive organs, mostly occurring in middle-aged women aged 30 to 50 years, and about half of the patients experience heavy periods, prolonged periods leading to anemia symptoms, infertility, lower abdominal cramps, and pelvic adjacent organ compression symptoms.  Adenomyosis is divided into diffuse and limited type, mostly diffuse growth and mostly involving the posterior wall of the uterus; focal type is less common, with limited growth of endometrium in the myometrium forming masses or nodules. In the past, it occurred mostly in menstruating women over 40 years of age, but in recent years there has been a gradual trend toward younger age. The etiology is still unknown, but the current consensus is that the uterus lacks a submucosal layer, so the cells of the basal layer of the endometrium proliferate and invade the myometrium, with compensatory hypertrophy of the surrounding cells of the myometrium and form the lesion. It may be associated with the increase of cesarean section and abortion.  Main manifestations: 1. Menstrual disorders (40~50%), mostly prolonged periods and increased menstrual flow, some patients may also have spotting bleeding before and after menstruation, leading to anemia.  2. Dysmenorrhea (25%): severe cases show unbearable dysmenorrhea. It often starts to appear a week before the menstrual period and is relieved when the period is over.  3.About 35% of patients have no obvious symptoms. About half of the patients have uterine fibroids in combination.  The blood supply of uterine fibroids and adenomyosis mainly comes from bilateral uterine arteries, most of them are bilateral, one side is predominant; some of them come from branches of ovarian arteries. According to the relationship between fibroids and myometrium, they can be divided into submucosal fibroids, interstitial fibroids and subplasma fibroids. The preliminary diagnosis can be made based on the typical history and physical signs, but histopathological examination is required to confirm the diagnosis. Imaging is the most effective means of preoperative diagnosis of the disease.  The traditional treatments for these two diseases are: 1) symptomatic treatment with medication (including Chinese medicine and the use of the Manned Ring); 2) surgical treatment (including radical and conservative surgery).  New methods–minimally invasive interventional therapy: Interventional therapy was first applied to the treatment of uterine fibroids by French physicians such as Ravina in the 1990s. With the improvement of radiological imaging technology and embolization materials, the interventional treatment of uterine adenomyosis was first reported in China in 2000. The treatment mechanism of UAE for uterine fibroids and adenomyosis is as follows: through UAE, the blood supply to the lesion is blocked to cause atrophy, degeneration and necrosis, and after embolization, the uterus can establish sufficient lateral circulation in a short period of time, so that the function of normal uterus is not affected, thus achieving the treatment. In addition, the secretion of prostaglandins and other substances that stimulate uterine contraction can be reduced, which can alleviate the symptoms of dysmenorrhea, and at the same time, with the reduction of the volume of the uterus and the area of the uterine cavity, the menstrual flow can be reduced or restored to normal accordingly, and the clinical symptoms of patients can be eliminated as a result. In addition to the uterine artery, the normal myometrial blood supply also includes the superior and inferior bladder, the inferior rectal and ovarian arteries. Since the smooth muscle of the adult myometrium is not sensitive to ischemia and hypoxia, UAE does not cause significant damage. Comprehensive literature reports that the overall benefit rate of UAE is 92%-96% (with a significant rate of 40%-70%, an effective rate of 30%-50%, and an ineffective rate of 3%-6%). This indicates that the efficacy of UAE is positive, but the long-term efficacy needs to be further observed.  In general, interventional treatment: 1, fast results, low recurrence rate, 2, less trauma, low cost, hospitalization 3-5 days can be discharged, 3, for their own leeway, even if the effect is not good, you can try other methods to avoid leaving regrets.