Uterine fibroids are smooth muscle tumors of the uterus, which are common benign tumors in the female reproductive organs. Depending on the location of growth, they can be classified as subplasma fibroids, interstitial fibroids, submucosal fibroids or cervical fibroids, broad ligament fibroids, etc. Different types of fibroids can show clinical manifestations such as excessive menstruation, lower abdominal mass or difficulty in urination or defecation.
The age of onset of the disease is usually about 20-50% of women aged 30-50 who suffer from uterine fibroids, but there are no clinical symptoms due to the slow development of the tumor, so in some cases, the disease is detected unintentionally because of physical examination, so most people are not treated earlier or even not treated.
Although uterine fibroids are benign lesions, there is a possibility of degeneration. It is mainly degenerative changes caused by various reasons. The main cause of degenerative changes is due to insufficient local blood supply of uterine fibroids, mostly unrelated to clinical symptoms.
I. Degeneration of uterine fibroids.
Glassy degeneration, cystic degeneration, red degeneration, steatosis: very rare, calcification, infection and suppuration, malignant degeneration.
II. Types of uterine fibroids.
Uterine fibroids can occur in any part of the uterus, and can be divided into uterine body fibroids and cervical fibroids according to the location of the fibroids, the former accounting for about 90%-96% of uterine fibroids, the latter accounting for only 2.2%-8%, and the presence of fibroids in both the cervix and the uterine body accounting for 1.8%. Cervical fibroids may grow under the mucosa of the anterior or posterior lip of the cervix, cervical fibroids may protrude into the cervical canal to form cervical fibroids with tissues, and cervical interstitial fibroids may gradually grow with the fibroids to make the cervix elongate, or protrude into the vagina or become embedded to fill the pelvic cavity, at which time the normal size of the uterine body is located on the huge cervix, pushing the uterus or bladder up into the lower abdomen and mutating the anatomical relationship between the two sides of the pelvis, increasing the risk of surgery. The risk of surgery is increased. They are classified into 3 categories according to their relationship with the myometrium
1. intermyometrial myomas.
The fibroids are located in the myometrium, surrounded by normal muscle layer, and the boundary between the fibroid and the muscle wall is clear. The large ones can enlarge the uterus or change the shape of the uterus to irregular protrusion, and often the uterine cavity is also deformed.
2. Subplasmalemmal fibroids.
Subplasma fibroids are called subplasma fibroids when the interstitial fibroids grow towards the plasma membrane layer on the surface of the uterus, so that the surface of the fibroids is only covered with a little muscle wall and plasma membrane layer, and when the fibroids continue to grow towards the subplasma membrane and form only a tip connected with the uterine wall, they are called subplasma fibroids with a tip. Subplasmalemmal leiomyosarcoma can be twisted, and due to obstruction of blood flow, the leiomyosarcoma tissues will break and fall off in the pelvic and abdominal cavity, and the tumor will become necrotic. Subplasma leiomyomas account for 20-30% of all leiomyomas, and due to the protrusion of leiomyomas, the uterus is enlarged, irregular in shape, uneven on the surface, and nodular in shape.
3. Submucosal leiomyoma.
Submucosal myomas are interstitial myomas close to the uterine cavity, growing in the direction of the uterine cavity and covered with endometrium on the surface, called submucosal myomas, which protrude from the uterine cavity and can change the shape of the uterine cavity, and some myomas are only attached to the uterine wall by their tissues, called submucosal myomas with tissues, which cause reflex uterine contraction as a foreign body in the uterine cavity and gradually move down to the endocervix due to gravity, and eventually the tissues are elongated This kind of fibroid accounts for about 10% of the total number of fibroids. Since the fibroids are located in the uterine cavity, the uterus mostly grows in a consistent manner, due to the pulling of the fibroids and the lack of blood supply to the fibroid tips, the uterus may have mild inversion and bleeding of the endometrium on the surface of the fibroids, necrosis and infection, causing irregular bleeding and increased discharge from the vagina. The above fibroids may occur in the same uterus at the same time, which is called multiple fibroids.
Treatment of uterine fibroids
1.Follow-up observation.
It is suitable for those whose fibroids are not large and whose increased menstrual flow is not obvious. The expectant therapy is regular follow-up observation without special treatment. It is mainly suitable for patients with uterine fibroids <5cm in size, asymptomatic or asymptomatic. If they are near menopausal women, they can expect the fibroids to shrink naturally after menopause.
2.Drug treatment.
It is suitable for near-menopausal patients whose fibroids are not large and whose increased menstrual flow is not obvious. Or preoperative treatment to prepare for surgery. Uterine fibroids are sex hormone-dependent tumors, and clinical treatment with hormonal drugs has been used for more than half a century, and a variety of drugs have been tried, but the drugs to cure fibroids are still in the process of exploration.
3.Surgical treatment.
It is the main treatment method of the disease. There are many traditional surgical methods for uterine fibroids, including total hysterectomy, subtotal hysterectomy, myomectomy, uterine artery embolization, open abdomen, minimally invasive hysterolaparoscopy and interventional embolization. Each of these methods has its own advantages and disadvantages, and the appropriate method should be chosen according to the specific situation of the patient.