Basic Introduction Alias: Fibroma, Uterine Fibroma English Name: Myanmar Clinic:Oncology Multi-group: Common Female Onset: Common Uterine Symptoms: Uterine Bleeding, Abdominal Mass, Compression, Pain, Leucorrhea, Infertility, Abortion, Anemia, Polycythemia, Hypoglycemia Infectious: No etiology, clinical manifestations, examination, differential diagnosis, treatment and causes. The causes of uterine fibroids are still unclear and may be involved. According to a large number of clinical observations and experimental results, hysteromyoma is a hormone-dependent tumor. Estrogen is the main factor to promote the growth of fibroids. Some scholars believe that growth hormone (GH) is also related to the growth of fibroids, and GH can promote mitosis in cooperation with estrogen, and it is speculated that human placental prolactin (HPL) can also promote mitosis in cooperation with estrogen. It is considered that the acceleration of uterine fibroids during pregnancy is not only related to the high hormone environment during pregnancy, but HPL may also be involved. In addition, ovarian function and hormone metabolism are controlled and regulated by higher nerve center, so the activity of nerve center may also play an important role in the pathogenesis of myoma. Because uterine fibroids are more common in women of childbearing age, widowed and uncoordinated sexual life. Chronic pelvic congestion caused by long-term sexual dysfunction may also be one of the causes of uterine fibroids. In a word, the occurrence and development of hysteromyoma may be the result of many factors. The clinical manifestation is 1. Most patients have no symptoms, only occasionally found during pelvic examination or ultrasound examination. If there are symptoms, it is closely related to the growth position, speed, degeneration and complications of fibroids, and has little to do with the size and quantity of fibroids. People with multiple submucosal fibroids may have no symptoms, but smaller submucosal fibroids often lead to irregular bleeding or menorrhagia. The common clinical symptoms are: (1) Uterine bleeding is the most important symptom of hysteromyoma, which occurs in more than half of patients. Among them, periodic bleeding is the most common, which can be manifested as increased menstrual flow, prolonged menstrual period or shortened cycle. It can also be manifested as irregular bleeding without menstrual cycle. Submucosal myoma and intramural myoma are more common in uterine bleeding, while subserous myoma rarely causes uterine bleeding. (2) Abdominal mass and compression symptom myoma gradually increased. When it enlarges the uterus for more than 3 months, or it is a large subserous myoma at the bottom of the uterus, it is often found in the abdomen, especially when the bladder is full in the morning. The lump is solid, movable and without tenderness. When the myoma grows to a certain size, it can cause symptoms of peripheral organ compression, and the myoma with the front wall of uterus close to the bladder can cause frequent urination and urgency. Huge cervical myoma pressing the bladder can cause dysuria and even urinary retention; Myoma of posterior uterine wall, especially myoma of isthmus or posterior cervical lip, can compress rectum, causing poor defecation and discomfort after defecation; Giant broad ligament myoma can compress ureter and even cause hydronephrosis. (3) Pain Under normal circumstances, uterine fibroids will not cause pain, but many patients will complain of abdominal distension and low back pain. Acute abdominal pain can occur when subserous myoma has pedicle torsion or uterine myoma has red degeneration, and it is not uncommon for myoma to have endometriosis or adenomyosis, so dysmenorrhea can occur. (4) Leucorrhea increases, uterine cavity increases, endometrial glands increase, and pelvic congestion can increase leucorrhea. When submucous myoma of uterus or cervix has ulcer, infection and necrosis, it will produce bloody or purulent leucorrhea. (5) Infertility and abortion Some patients with uterine fibroids are accompanied by infertility or easy abortion. The influence on pregnancy and pregnancy outcome may be related to the growth position, size and number of fibroids. Giant hysteromyoma can cause uterine cavity deformation, hinder pregnancy sac implantation and embryo growth and development; Myoma compression of fallopian tube can lead to lumen obstruction; Submucosal myoma can hinder implantation of gestational sac or affect * * * entering uterine cavity. The spontaneous abortion rate of patients with hysteromyoma is higher than that of normal people, and the ratio is about 4∶ 1. (6) Anemia can be caused by long-term menorrhagia or irregular bleeding, and more serious anemia is more common in patients with submucosal myoma. (7) A few other patients with hysteromyoma can produce polycythemia and hypoglycemia, which is generally considered to be related to ectopic hormones produced by tumors. 2. Signs (1) Abdominal examination showed that the uterus was enlarged for more than 3 months, or the subserous myoma at the bottom of the uterus was large. The mass can be palpated above the pubic symphysis or in the middle of the lower abdomen, which is solid and has no tenderness. If it is multiple hysteromyoma, the shape of the lump is irregular. (2) Pelvic examination in Shuanghe Town, Gynecology Department, and triple diagnosis showed that the uterus was enlarged in different degrees, irregular, with irregular protrusions on the surface of the uterus, solid, and soft in texture if there was degeneration. The signs of hysteromyoma in gynecological examination are different according to their different types. If the subserous myoma with pedicle is long, it can touch the solid mass beside the uterus and move freely, which is easy to be confused with ovarian tumor. Submucosal myoma descends to the cervix, and the cervix relaxes. The examiner's fingers can touch the smooth spherical tumor in the cervix. If it has emerged from the cervix, you can see the tumor with a dark red surface and sometimes ulcers and necrosis. Larger cervical fibroids can displace and deform the cervix, and the cervix can be flattened or moved up behind the pubic symphysis. Examination 1. Ultrasound examination is the most commonly used auxiliary diagnosis method at present. It can show the enlargement and irregular shape of uterus, the number, position and size of myoma, and whether the interior of myoma is uniform or liquefied, cystic change and so on. Ultrasound examination is not only helpful for the diagnosis of hysteromyoma, but also can provide reference for differentiating hysteromyoma from ovarian tumor or other pelvic masses. 2. Diagnostic curettage detects the size and direction of the uterine cavity through the uterine cavity probe, feels the shape of the uterine cavity, and knows whether there is a lump in the uterine cavity and its location. For patients with abnormal uterine bleeding, it is often necessary to differentiate endometrial lesions, and diagnostic curettage is of great value. 3. Hysteroscopy can directly observe the shape of uterine cavity and whether there is vegetation under hysteroscopy, which is helpful for the diagnosis of submucosal myoma. 4. Laparoscopy When fibroids need to be differentiated from ovarian tumors or other pelvic masses, laparoscopy can directly observe the size, shape and tumor growth site of the uterus and preliminarily judge its nature. 5. magnetic resonance imaging generally speaking, magnetic resonance imaging is not necessary. If it is necessary to distinguish hysteromyoma from hysterosarcoma, magnetic resonance imaging, especially enhanced delayed imaging, is helpful to distinguish hysteromyoma from hysterosarcoma. Before laparoscopic surgery, magnetic resonance imaging (MRI) examination is also helpful for clinicians to know the location of myoma before and during surgery and reduce the residue. The differential diagnosis of myoma is often confused with the following diseases and should be differentiated: ① adenomyosis and adenomyoma; ② Pregnant uterus; ③ Ovarian tumor; ④ Malignant tumor of uterus; ⑤ uterine hypertrophy; ⑥ Uterine varus; ⑦ Uterine malformation; ⑧ Pelvic inflammatory mass. Treatment 1. Follow-up observation If the patient has no obvious symptoms or signs of malignant transformation, he can be followed up regularly. 2. Drug therapy (1) Gonadotropin-releasing hormone agonist (GnRH-a) At present, leuprorelin, goserelin and triptorelin are commonly used in clinic. GnRH-a should not be used continuously for a long time, but only for preoperative pretreatment, usually for 3 ~ 6 months, so as to avoid serious menopausal symptoms caused by low estrogen; Small doses of estrogen can also be supplemented to combat this side effect. (2) Mifepristone is a progesterone antagonist. In recent years, trying to treat uterine fibroids in bed can reduce the volume of fibroids, but fibroids often grow back after stopping taking drugs. (3) Danazol is used for preoperative medication or treatment of uterine fibroids that are not suitable for surgery. Uterine fibroids can grow up after stopping taking drugs. Taking danazol can cause liver function damage, in addition to the side effects caused by androgen (weight gain, acne, dullness, etc. (4) tamoxifen can inhibit the growth of fibroids. However, for a long time, the enlargement of uterine fibroids in some patients, even inducing endometriosis and endometrial cancer, should be paid attention to. (5) Androgen drugs commonly used drugs are methyltestosterone (methyltestosterone) and testosterone propionate (testosterone propionate), which can inhibit the growth of fibroids. Pay attention to the dosage and don't cause masculinity. In the bleeding period of patients with hysteromyoma, uterine contractions (such as oxytocin and ergot) and hemostatic drugs (such as hemostatic acid, aminotoluene acid (hemostatic aromatic acid), reptilase, Sanqi tablets, etc. ) can also help stop bleeding to some extent. 3. Surgical treatment of uterine fibroids Surgical treatment includes myomectomy and hysterectomy, which can be performed via abdomen or via * * *, and endoscopic surgery (hysteroscopy or laparoscopy) is also feasible. The choice of surgical method and surgical approach depends on the patient's age, whether there are fertility requirements, the size and growth position of fibroids, medical technical conditions and other factors. (1) Hysteromyomectomy is an operation to remove hysteromyoma and preserve the uterus. It is mainly used for young women under 40 who want to preserve their fertility. Suitable for large fibroids; Menstruation; Have symptoms of oppression; Infertility caused by fibroids; Submucosal myoma; Myoma grows rapidly but has no malignant transformation. (2) Hysterectomy should be performed if the symptoms are obvious, the myoma may become malignant and there is no fertility requirement. Hysterectomy can choose total hysterectomy or subtotal hysterectomy, which is suitable for the elderly. The possibility of cervical malignant disease must be ruled out before operation. (3) Uterine artery embolization: by means of radiation intervention, the arterial catheter is directly inserted into the uterine artery, and permanent embolic particles are injected to block the blood supply of uterine fibroids, so as to achieve the purpose of atrophy or even disappearance of fibroids. At present, UAE is mainly suitable for symptomatic uterine fibroids such as anemia caused by abnormal uterine bleeding. The choice of interventional therapy for hysteromyoma should be cautious, especially patients with uncontrolled pelvic inflammatory disease, patients who want to preserve reproductive function, patients with arteriosclerosis and patients who have contraindications to angiography themselves should be listed as contraindications for this treatment. 5% patients have the possibility of premature ovarian failure after operation, and there are few reports of pelvic infection. 4. Focused ultrasound therapy Through focused ultrasound, the internal temperature of the tumor locally rises above 65℃, which leads to tumor coagulation and necrosis, thus playing a therapeutic role. Treatment can reduce fibroids and relieve symptoms. It is suitable for symptomatic uterine fibroids. There is no surgical scar after treatment, and quick recovery after operation is its advantage. Side effects include skin scald, adjacent intestinal injury, hematuria and so on.