(Disclaimer: This article is for scientific use only, and the information in the following content has been processed to protect patient privacy)
Abstract: Auntie Zhang, 50 years old, was found to have uterine fibroids during a physical examination 5 years ago, and then did not pay attention to it and was not treated. Six months ago, she developed urinary urgency and recently developed abdominal distension and abdominal mass. Combined with ultrasound, hysteroscopic scraping and MR scan plus enhancement of the pelvic area, the diagnosis of uterine fibroids was confirmed and the tumor was large. After surgery and drug treatment, the condition was basically stable, and the symptoms of urinary urgency, abdominal distension and abdominal masses were significantly relieved, and the abdominal wound was dry and healing well.
Basic information】Female, 50 years old
Disease Type】Smooth muscle tumor disease (uterine fibroids)
Hospital】Qilu Hospital of Shandong University
Date of consultation】January 2022
Treatment plan】Surgical treatment (hysteroscopic diagnostic curettage, laparoscopic myomectomy) + oral medication (Gui Zhi Fu Ling Wan) + intravenous infusion (flurbiprofen ester injection, spearhead viper hemagglutinase for injection)
Treatment period】5 days of hospitalization and regular follow-up after discharge
Treatment effect】The patient’s somatic symptoms disappeared, the abdominal wound was dry and healed well
I. Initial consultation
Patient Auntie Zhang, 50 years old, menopausal, reported that her uterine fibroids were found during a physical examination 5 years ago. Three months ago, the patient underwent an ultrasound examination of the abdomen and found that the fibroids had increased in size, so she was treated accordingly, but the results were not good.
After hearing the patient’s past medical history, the patient was immediately given routine checkups, including routine blood and urine tests, and the abdominal ultrasound was repeated, which showed that the tumor had increased in size compared to 3 months earlier and was pressing on the bladder. Based on the patient’s past medical history and examination results, the diagnosis of uterine fibroids was made.
II. Treatment history
Diagnostic hysteroscopic curettage was performed, and the scraped tissue was sent for pathological examination, which showed a small amount of mucosa with squamification in the cervical canal and a proliferative endometrium. The patient was given a pelvic MR scan with enhancement, which showed a small amount of fluid in the pelvic cavity and a subplasma type of uterine fibroid with degeneration, suggesting a benign lesion.
The patient’s clinical manifestations and the corresponding examinations were consistent with the indication for surgery, and after discussion with the patient, surgical treatment was chosen. The patient was treated with intravenous flurbiprofen injection for pain management and intravenous injection of spearhead viper hemagglutinase for hemostasis, and oral administration of Gui Zhi Fu Ling Wan for blood circulation and stasis removal. On the 5th postoperative day, the patient’s condition was basically stable and the wound healed well, so he was given discharge from the hospital and followed up for 4 weeks after discharge.
III. Treatment effect
After admission, the patient was treated with active surgery and medication, and his abdominal distension, urinary urgency and abdominal mass symptoms basically disappeared. On the first postoperative day, the patient had slight pain at the abdominal wound site, and there was no obvious blood leakage from the wound site, and the symptoms of abdominal mass, abdominal distension and urinary urgency gradually decreased. On the third postoperative day, the patient’s abdominal wound pain disappeared and the wound healed well without any blood or fluid leakage. On the 5th postoperative day, the patient’s abdominal wound site was well healed and dry, and the symptoms of urinary urgency, abdominal distension and abdominal mass were obviously relieved.
IV. Precautions
After active surgical treatment and postoperative medication, the patient’s surgery went smoothly, the fibroids were completely removed, and the postoperative recovery was good, and I was sincerely happy for the patient. However, since the patient was not completely cured when she was discharged from the hospital, she still needs to pay attention to the following points.
1, daily life need to pay attention to personal hygiene, diligent cleaning of the vulva or change of underwear, underwear material can choose pure cotton material.
2. In the early stage of discharge, patients should try to choose light and easily digestible food, such as appropriate millet porridge, spinach, etc., and avoid stimulating food, such as chili pepper and pepper.
3.After discharge, patients need to closely monitor the changes in their condition and go to the hospital at any time if they have any uncomfortable symptoms.
V. Personal insight
Uterine fibroids, or uterine smooth muscle tumor disease, is a relatively common benign tumor in women, mostly caused by genetics, sex hormones and other factors. If the patient is asymptomatic, no special treatment is needed, but if, like the patient in this case, the fibroids are large enough to compress the surrounding tissues and cause symptoms, the patient needs to be actively treated by surgical removal of the tumor, and the patient needs to be observed in a timely manner after surgery, and to be seen if there is any discomfort.