When it comes to tumors, most people are shocked. There is a tumor that is one of the common diseases in women, but it is benign, which is the uterine fibroids.
Many women find uterine fibroids in the physical examination and gynecological B overtime, and usually have no feelings at all and do not have any symptoms. Among them, 30% to 40% of patients develop symptoms. This is closely related to the location of fibroids, the rate of growth, and the presence or absence of degeneration of fibroids. Although uterine fibroids are benign tumors, improper treatment will still bring a lot of trouble to our lives. So should the fibroids be removed so as to avoid the consequences?
Which symptoms occur should be considered surgery
The front of the uterus is the bladder, the posterior is the rectum, and when the uterine fibroids are larger, they can compress the bladder and rectum, and the corresponding compression symptoms appear. At this time, patients usually have symptoms of urinary frequency, dysuria, and urinary retention, and a small number of patients develop stress urinary incontinence.
If the fibroids grow under the serous membrane of the uterus, the patient develops acute abdominal pain when the fibroid pedicle twists occur. In the case of red degeneration (unexplained necrosis) of fibroids, patients may also have abdominal pain with fever. If uterine fibroids grow under the uterine mucosa, the patient's menstruation will also change.
Patients are advised to consider surgery when:
01
Uterine fibroids with menorrhagia or abnormal bleeding and even cause anemia; or compress the urinary system, digestive system and nervous system, etc., the symptoms of related symptoms appear, and drug treatment is ineffective.
02
Uterine fibroids are combined with infertility.
03
When patients with uterine fibroids prepare for pregnancy, the fibroids are larger than 4 cm in diameter.
04
No hormone therapy was given after menopause, but fibroids continued to grow.
Which fibroids should not be laparoscopic
Surgical pathways for uterine fibroids include laparoscopic surgery, open surgery, hysteroscopic surgery, and negative surgery. Laparoscopy is favored by patients because of its small wounds, fast postoperative recovery, and light adhesions. But not all uterine fibroids can be removed by laparoscopic surgery.
For fibroids with a large number of fibroids with a large diameter (e.g., greater than 10 cm), located in a special location such as submucosa, laparoscopic surgery is more difficult, which will prolong the operation time, increase the amount of bleeding, suture difficulties, and may also increase the risk of postoperative recurrence and pregnancy uterine rupture. Open surgery is recommended in this case. No matter what kind of surgery, as long as the best treatment effect is achieved with minimal trauma, it is the best way to operate.
In addition, for leiomyomas and leiomyomas with malignant potential, because there may be a risk of tumor dissemination during fibroid crushing (supported by grade III.-B evidence), open surgery is recommended. If laparoscopic surgery is applied it is recommended to use a withdrawal bag to avoid the risk of dissemination.
What to do if pregnancy is complicated by uterine fibroids
The incidence of pregnancy with uterine fibroids ranges from 0.1% to 3.9%. With the implementation of the three-child birth policy, the number of pregnancies with uterine fibroids should increase.
Most pregnant women with uterine fibroids can smoothly pass through pregnancy. However, some pregnant women have also developed complications. During pregnancy, uterine fibroids enlarge, a small number of fibroids degenerate, and patients develop abdominal pain. Among them, doctors are most worried about uterine fibroids during pregnancy to induce complications, threaten the health of the fetus, or cause uterine damage to affect future fertility.
Uterine fibroids do increase the probability of dystocia, caesarean section, and preterm birth, especially large submucosal fibroids and fibroids at the site of placental attachment can lead to complications such as pain (fibroid degeneration), vaginal bleeding, placental abruption, and preterm birth, and if it is a lower uterine fibroid or cervical fibroid, there is a risk of obstructing the birth canal and causing obstructed labor.
The management of pregnancy with uterine fibroids is mainly conservative. Surgery is performed in pregnant women with severe pain due to subserosal fibroids or fibroid pedicle torsion and ineffective drug therapy, or in pregnant women with peritonitis of fibroid necrosis, and only in the early and middle trimesters.
However, there is a lack of evidence-based medical evidence on the effects of both open and laparoscopic surgery on pregnancy outcomes. Uterine fibroid removal during cesarean section carries the risk of serious complications. Therefore, patients with large uterine fibroids should undergo uterine fibroid removal before becoming pregnant.
Author: Department of Obstetrics and Gynecology, Peking University People's Hospital, Yang Xin, Li Huiling
Review: Expert of the National Health Science Popularization Expert Database
Beijing Shijitan Hospital affiliated to Capital Medical University
Chief Physician of obstetrics and gynecology Bai Wenpei
Planner: Wu Weihong, Tan Jia
Editor: Luan Zhaolin