Uterine fibroids are one of the most common benign tumors in the female reproductive organs and one of the most common tumors in the human body. They are also called fibroids and uterine fibroids. Because uterine fibroids are mainly composed of the proliferation of uterine smooth muscle cells and a small amount of fibrous connective tissue exists as supporting tissue, they are more accurately called uterine leiomyoma. Uterine fibroids. Let’s look at the treatments for uterine fibroids. 1. Focused Ultrasound Therapy The temperature inside the tumor is raised locally to above 65°C, causing coagulative necrosis of the tumor and exerting a therapeutic effect. The treatment can shrink the fibroids and relieve symptoms. It is suitable for symptomatic uterine fibroids. There are no surgical scars after treatment, and the advantages are fast recovery after surgery. Side effects include skin burns, intestinal damage, hematuria, etc. 2. Follow-up Observation If the patient has no obvious symptoms and no symptoms of malignancy, regular follow-up observation can be performed. Expectant Treatment Expectant therapy is regular observation and does not require special treatment. It is mainly suitable for asymptomatic uterine fibroids, especially patients with a uterine size of <10-12 weeks of pregnancy. If they are near-menopausal women, it is expected that the fibroids will shrink naturally after menopause. In addition, some asymptomatic small fibroids found during health examinations are common in clinical practice, and patients often go to the doctor anxiously. These patients are diagnosed with uterine fibroids after careful examination and can be treated expectantly without surgical treatment. Review every 3-6 months, paying attention to whether there are symptoms during the period and whether the uterus is enlarged. Each follow-up requires a gynecological examination, supplemented by B-ultrasound. If symptoms of menorrhagia and compression occur during the follow-up or the fibroids grow particularly fast, surgical treatment should be performed. It is appropriate to use expectant treatment for asymptomatic uterine fibroids under the supervision of regular follow-up. IV. Drug Treatment (1) Commonly used androgen drugs include methyltestosterone (methyltestosterone) and testosterone propionate (testosterone propionate), which can inhibit the growth of fibroids. Pay attention to the dosage to avoid masculinization. (2) Mifepristone is a progesterone antagonist that has been clinically used in the treatment of uterine fibroids in recent years. It can reduce the size of fibroids, but the fibroids grow more after discontinuation of the drug. (3) Gonadotropin-releasing hormone agonist (GnRH-a) Commonly used GnRH-a in clinical practice include leuprorelin (Enanton), goserelin (Zorelaide), triptorelin (Dapiga), etc. GnRH-a should not be used for a long time and is only used for preoperative pretreatment, generally for 3 to 6 months, to avoid causing severe menopausal symptoms caused by low estrogen; small doses of estrogen can also be supplemented to resist this side effect. (4) Tamoxifen can inhibit the growth of fibroids. However, long-term use may cause some patients’ uterine fibroids to grow larger and even induce endometriosis and endometrial cancer, so this should be taken with caution. (5) Danazol is used for preoperative medication or treatment of uterine fibroids that are not suitable for surgery. Uterine fibroids may grow after discontinuation of medication. Taking danazol can cause liver damage and androgenic side effects (weight gain, acne, low voice, etc.). 5. Interventional treatment Interventional treatment occurred in the last century, mainly injecting embolic agents into the uterine artery to embolize the fibroid blood vessels, leading to ischemic necrosis in the fibroids. However, due to the rich blood supply of the uterus, the actual effect is not ideal. Gynecological clinics sometimes see some patients who found uterine fibroids during the cancer prevention survey. Some women think that uterine fibroids are "cancer tumors", so when I heard that there was a tumor on the uterus, I was very nervous and under great mental pressure. In fact, uterine fibroids are not terrible. It is the most common benign tumor in the female pelvis. The rate of malignant change is very low, only 0.3% to 1.39% of married women of childbearing age, and 39% of them are patients with uterine fibroids. 6. Surgical treatment (1) Myomectomy The surgery to remove uterine fibroids and preserve the uterus is mainly used for young women under 40 who want to retain their fertility. It is suitable for large fibroids; heavy menstruation; compression symptoms; infertility caused by fibroids; submucosal fibroids; fibroids that grow rapidly but do not become malignant. (2) Hysterectomy Hysterectomy is suitable for women with obvious symptoms, the possibility of malignant changes in fibroids, and no fertility requirements. Hysterectomy can be performed as a total hysterectomy or a subtotal hysterectomy. Women who are older are suitable for total hysterectomy. The possibility of cervical malignancy must be ruled out before surgery. (3) Uterine artery embolization The arterial catheter is directly inserted into the uterine artery, and permanent embolic particles are injected to block the blood supply to the uterine fibroids, causing the fibroids to shrink or even disappear. UAE is currently mainly suitable for uterine fibroids with symptoms such as anemia caused by abnormal uterine bleeding. When choosing interventional treatment for uterine fibroids, caution should be exercised, especially for patients with uncontrolled pelvic inflammation, patients who wish to retain fertility, arteriosclerosis, and contraindications to angiography should be listed as contraindications to this treatment. 5% of patients may have premature ovarian failure and rare pelvic infections after surgery. |
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