Uterine leiomyoma can be divided into mesenchymal tumor, subserous tumor, submucosal tumor and broad ligament leiomyoma according to different parts of uterus. If the myoma is small and has no symptoms, complications and degeneration, especially if it is close to menopause, it can be left untreated for the time being, with observation and reexamination as the main task. If there is swelling or symptoms, surgical treatment should be considered. Usually, the standard of surgical treatment is fibroids (together with uterus). Those who reach the uterus size of two and a half months of pregnancy, or those who are anaemic or degenerate due to menorrhagia after drug treatment is ineffective, should also consider surgery. However, for the same surgical treatment, the specific surgical methods are still different, and doctors need to comprehensively analyze the actual situation of the patient's age and fertility. Therefore, before the operation, the doctor will communicate the operation plan with the patient in detail, and then implement it after reaching an understanding with the family.
The operation of hysteromyoma mainly refers to hysterectomy (including total resection and semi-resection). Hysteromyomectomy is generally suitable for those who are pregnant for more than 3 months. Although hysteromyoma is small, but the symptoms are obvious or the myoma grows rapidly, malignancy cannot be ruled out. Removal is mainly suitable for unmarried and infertile women under 35 years old. With the wide application of minimally invasive surgery in clinic, most hysteromyoma operations can be completed with the assistance of laparoscopy and hysteroscopy. Minimally invasive surgery changed the original incision of more than ten centimeters into two or three fierce wounds of 0.5- 1 cm in the abdomen, and turned the centipede-like scar in the abdomen into a faint trace, shortening the hospitalization time. Patients can usually be discharged after two days of observation, and recover quickly after operation. Greatly improved the quality of life and alleviated the physical and mental pain of patients. A patient who finished laparoscopic surgery in the gynecology department of Renai Hospital said: I couldn't believe that the operation would be so easy if I hadn't seen the B-ultrasound report that the hysteromyoma disappeared. In addition to surgical treatment, there are also drug treatments, which are generally suitable for some patients with recent menopausal hysteromyoma whose symptoms are not obvious or their general condition is poor. Now there is another treatment: uterine artery ligation or vascular embolization, but after the operation, uterine fibroids will shrink but still exist.
Expectation therapy
Myoma is small, asymptomatic, without complications and degeneration, and has no influence on health. Perimenopausal patients have no clinical symptoms, and the myoma can shrink or shrink after ovarian dysfunction. All the above conditions can be treated with expectation therapy, that is, regular follow-up observation (65,438+0 times in 3 ~ 6 months). Can be decided according to the review.
drug therapy
There are many new advances in drug therapy.
Third, surgical treatment.
In the past, the age of hysteroappendectomy for patients with fibroids was set at over 45 years old. Now it seems that according to the progress of gynecological endocrinology, the age of ovarian preservation is generally 50 years old (the average age of menopause is 49.5 years old), that is, all those who can preserve ovaries within 50 years old should be preserved. Or the normal ovaries of premenopausal women after the age of 50 should also be preserved without age labeling. Because normal postmenopausal ovaries still have certain endocrine function, they still have to work for 5 ~ 65438. +00 years. Preserving ovaries helps to conceal autonomic nervous regulation metabolism and is beneficial to the transition to old age. The uterus also has endocrine function. It is the target organ of the ovary and should not be removed casually. Usually, the age of hysterectomy is over 45 years old and under 45 years old, especially under 40 years old, which is suitable for hysteromyomectomy. It is better to keep both sides of the appendix than to keep only one side. The incidence of ovarian cancer with preserved ovaries is 0. 15%, which is not higher than that of ovarian cancer without hysterectomy.
Life care: The treatment of hysteromyoma depends on the patient's age, symptoms, location, size, growth rate, number, uterine deformation, whether to retain fertility function and the patient's wishes.