Conservative treatment of hysteromyoma must meet the following conditions: 1. The gestational age of the tumor should not exceed 6 weeks; Second, menopause, asymptomatic; Third, non-surgical treatment can reduce the amount of bleeding in near menopause; Fourth, it can't stand surgery. Conservative treatment mainly includes expectation therapy and drug therapy.
1. Expecting treatment: The patient is over 40-50 years old, near menopause, and has no obvious symptoms such as excessive bleeding and pain. At this time, clinical observation can be carried out for a period of time, and gynecological internal medicine diagnosis and B-ultrasound examination can be carried out every 3 months. If the tumor-free body grows rapidly and the symptoms of bleeding and pain are not aggravated, we can expect uterine fibroids to shrink day by day with the increase of age and the decrease of estrogen level.
2. Drug treatment: At present, conservative treatment is mainly drug treatment, which can avoid the pain and sequelae caused by surgery. If the general drug treatment is not ideal, we can consider minimally invasive or surgical treatment. Traditional Chinese medicine decoction and Chinese patent medicine are used to regulate the endocrine and microcirculation of patients, regulate qi and blood, remove blood stasis and eliminate uterine fibroids from the source.
Second, the surgical treatment of uterine fibroids
When the size of myoma is equivalent to more than one and a half months of pregnancy, surgical treatment should be considered. In addition, if the myoma grows rapidly, the clinical symptoms are obvious, and the tumor protrudes into the abdominal cavity and has a distorted tendency, it should also be surgically removed. Of course, other indications should be considered when determining the operation, such as severe anemia, heart disease and general condition. The operation method can be determined according to the size of myoma, the age of symptoms and the patient's requirements for fertility. Surgical treatment methods are:
1. Hysteromyomectomy: It is suitable for patients who want to preserve their reproductive function. It can be removed by abdomen or laparoscopy, and submucosal myoma can be removed by vagina or hysteroscopy. There is a 50% chance of recurrence after operation, and about13 patients need reoperation.
2. Hysterectomy: Hysterectomy is feasible for those who do not need to preserve their reproductive function or are suspected of malignant transformation. Cervical smear cytology should be performed before operation to exclude cervical malignant lesions.
3. Minimally invasive surgical treatment: The Gynecological Minimally Invasive Center of 307 Hospital of Beijing People's Liberation Army introduced the advanced gynecological hysteroscopy system of Olympus in Japan and Karl in Germany.
STORZ gynecological laparoscopic system can completely cure uterine fibroids. Japanese Olympus hysteroscope is a set of system including mirror body, camera, lighting and monitor. Different sheaths are sleeved on the mirror body with a diameter of 2.7-4mm, which can complete inspection, intubation, electrotomy and other operations respectively. Karl, Germany
STORZ gynecological laparoscopic system is the most advanced laparoscopic surgery equipment so far, which integrates examination, treatment, surgery and image display. Hysteroscopic surgery is mainly suitable for menorrhagia, abnormal uterine bleeding, submucosal myoma or uterine cavity protrusion.
Laparoscopic treatment has the advantages of small incision, only 0.5- 1.0cm, accurate operation, direct targeting at the lesion site, no damage to normal tissues, less pelvic adhesion, rapid postoperative recovery, and most patients can walk and eat in the afternoon of the operation, with less wound pain, less postoperative fever and less infection. Hysteroscopy is the best choice for patients with hysteromyoma, which is minimally invasive, does not harm the surrounding tissues, can preserve the integrity of the female uterus, does not affect fertility, and conforms to the aesthetic psychology of young people.