Zhang Yi, deputy director of the Department of Obstetrics and Gynecology of Beijing Hospital, is a chief physician with rich clinical experience. She improved vaginal hysterectomy and carried out vaginal myomectomy, bringing good news to patients who want to preserve their fertility and have scruples about hysterectomy. (Left)
Luo Lihua, the chief physician and deputy director of the Department of Obstetrics and Gynecology of Beijing Hospital, studied in the Department of Obstetrics and Gynecology of Nara Medical University, and has rich clinical experience in the diagnosis and treatment of gynecological tumors, infertility, habitual abortion and high-risk pregnancy. (right)
Hello, audience friends! This is CCTV's "Healthy Road" live program. Today, we will talk about the problem of treating hysteromyoma without laparotomy.
Moderator: Let's watch a movie first. Sister Wang, 48, works in a state organ. Two years ago, she found a 6 cm myoma in a physical examination. She didn't care too much at that time. Two days ago, she found that she had grown to 10 cm and needed an operation. Patient: "I am always worried that after the operation, the female characteristics are not obvious, and more will be male characteristics. I don't want to have surgery and want to be a complete woman."
Moderator: Will there be these situations that patients are worried about after hysterectomy?
Zhang Yi: It is the ovary that maintains female characteristics, and surgery will not affect the female characteristics of patients.
Moderator: Are there many patients with hysteromyoma like Sister Wang in real life?
Luo Lihua: In real life, the incidence of female hysteromyoma is still very high. The proportion of women aged 30 -50 suffering from hysteromyoma is 20%.
Zhang Yi: In recent years, it is believed that the reason why so many women suffer from uterine fibroids is probably related to the stimulation of estrogen and progesterone, because the age group with frequent uterine fibroids (30-50 years old) is often the most vigorous period of female reproductive function, and the stimulation of estrogen and progesterone is relatively more, and postmenopausal uterine fibroids will gradually shrink or even disappear. Clinically, it is found that women with uncoordinated sexual life, unmarried women and infertile women are more likely to suffer from uterine fibroids. In addition, uterine fibroids also have a certain genetic tendency.
Luo Lihua: Not all patients with hysteromyoma will have corresponding symptoms. Whether there are symptoms is related to the size of myoma and the growth site of myoma. As shown in the figure, this is an inverted schematic diagram of the uterus. Many prominent parts in the picture are uterine fibroids. If fibroids grow into the uterine cavity, the area of the uterine cavity will increase, menstruation will also increase, and symptoms will gradually appear. If the myoma is large, but the growth direction is outward, there will be no corresponding symptoms, but once the growth of the myoma oppresses the bladder or rectum, there will be corresponding symptoms, such as always wanting to urinate or constipation.
Moderator: How to find asymptomatic uterine fibroids as soon as possible?
Zhang Yi: Many gynecological tumors are asymptomatic in the early stage, so we should pay special attention to gynecological physical examination. Women over the age of 30 should have a physical examination every year, which is very beneficial to early detection and treatment of diseases. In addition, it should be clear that uterine fibroids are benign fibroids, and patients should not have psychological burden. The malignant rate of uterine fibroids is very low, only about three to five thousandths. Surgery for hysteromyoma is necessary. 1. Uterine fibroids must be operated for 3 months. It is believed that such a large hysteromyoma will not shrink by itself even after menopause, and it is easy to degenerate and has adverse effects on the body. 2. If the tumor grows very fast and becomes malignant, surgery may be needed. 3. If it is impossible to judge whether the tumor belongs to hysteromyoma or ovarian tumor, it is necessary to actively treat it. 4. Uterine fibroids that affect reproductive function must be operated. 5. symptomatic uterine fibroids must be operated.
Moderator: Ms. Chen from Chifeng, Inner Mongolia, aged 53. In 1998, hysteromyoma, 2.9×3.2 cm, was found. This year, I found that I grew up with B-ultrasound, 5.9×5.2 cm, and now my back hurts badly. Some doctors say that menorrhagia requires surgery, and some doctors say that postmenopausal fibroids will naturally shrink. What should I do in this case?
Luo Lihua: It is recommended that patients have surgery, because patients' fibroids grow fast and are prone to malignant transformation, and too much menstrual flow can easily lead to anemia. If the patient has concerns about the operation, observe it for a period of time before deciding whether the operation is ok.
Moderator: Ms. Zhang from Heilongjiang, 52 years old. I had my uterus and ovaries removed last year because of hysteromyoma. Do I need to take hormones? It doesn't have to have any impact.
Zhang Yi: Patients can take hormones to prevent osteoporosis, but the medication should be carried out under the guidance of a doctor. If you don't take hormones, menopausal symptoms may be worse.
Moderator: If a young infertile woman suffers from hysteromyoma, should she treat hysteromyoma first or get pregnant first?
Luo Lihua: It should be analyzed according to the specific situation of patients. If the cause of infertility after examination is caused by fibroids or repeated abortion after pregnancy, fibroids should be treated before pregnancy. In addition, if the growth rate of fibroids before pregnancy is too fast, in order to avoid malignant transformation of fibroids, fibroids should be treated first.
Moderator: How to treat hysteromyoma without laparotomy?
Luo Lihua: Non-laparotomy is hysterectomy through vagina. Compared with traditional surgery, there is no need to operate in the abdomen, and the trauma is relatively small.
Compere: Is colposcopy and cervical mirror the same concept?
Zhang Yi: It's not the same thing. Colposcopy is used to observe cervical lesions, and hysteroscopy is used to check or treat uterine cavity diseases.
Moderator: What are the characteristics of total hysterectomy?
Zhang Yi: Total hysterectomy has existed for a long time. It is used to treat patients with uterine prolapse or small uterus. It is difficult for patients with hysteromyoma to do this kind of operation, which is limited to some extent. After the improvement of the operation, the operation has the following two characteristics: 1, which expands the surgical field of vision. 2. Simplify the operation method and shorten the operation time. The operation only takes about 40 minutes, which not only has little interference to the abdominal cavity, but also has no wound in the abdomen, and the postoperative recovery is good.
Moderator: If the patient wants to keep the uterus and have a baby, is there a better solution?
Zhang Yi: This year, we have performed vaginal myomectomy for patients who have retained their fertility function, single uterine myoma or are particularly worried about hysterectomy. The largest myoma of uterus removed clinically is 490 grams. Hysteromyoma may recur. The recurrence rate of single hysteromyoma is about 65438 02%, and the recurrence rate of multiple hysteromyoma is about 40%.
Moderator: Let's watch a movie. The patient has just finished hysterectomy to see how he is recovering. Patient: "This kind of operation has no scars and no pain. My mother had an abdominal resection for hysteromyoma in 1998. Because of my age, my ovaries have also been cut off. The operation not only left a scar, but also was very painful. Now I can't see the outside after the operation, and the inside is very clean. I felt very lucky the day after the operation. "
Zhang Yi: The patient is 3 1 year old and has never given birth. It was a myoma of the anterior wall, weighing 80 grams.
Moderator: Ms. Guo, a native of Liaoning, aged 38. Three years ago, hysteromyoma 1 cm was diagnosed and interventional therapy was performed. It's 3 centimeters now. What should I do?
Luo Lihua: Interventional therapy can't cure hysteromyoma. Don't be too nervous about the patient's condition, and check it every three months.
Moderator: Ms. Gao from Jiangsu, 37 years old. I have suffered from hysteromyoma for more than two years. The largest is 3.7 cm. It became smaller after taking the medicine, but it remained the same after stopping taking the medicine. Is there any better treatment?
Zhang Yi: We don't advocate drug treatment for 3.7 cm uterine fibroids. We can observe it first, and if it continues to grow, we can treat it with other methods (such as surgery).
Moderator: Will myomectomy affect fertility?
Zhang Yi: Hysteromyomectomy is to preserve the fertility of patients and should not affect the fertility. However, it should be noted that those who do not pass through the uterine cavity after myomectomy should use contraception for half a year and the uterus should fully recover. Contraceptive measures should be taken at least one year after myomectomy.
Moderator: Ms. Liu from Inner Mongolia, 29 years old. I just finished my myomectomy. What are the precautions now?
Luo Lihua: In addition to the contraceptive needs mentioned above, sexual life should be forbidden for 1-2 months after operation.
Moderator: Ms. Tan from Heilongjiang, 39 years old. I have had hysteromyoma for 4 years, and there is nothing unusual. Can I not have an operation? Is it possible to cause cancer?
Zhang Yi: Patients should go to the hospital for relevant examinations to see if fibroids have grown out now, whether the growth rate is very fast and so on. If there is a possibility of cancer, the doctor should judge whether to have an operation.
Moderator: Ms. Xu, from Anhui, is 48 years old. I went to the hospital for examination because of irregular menstruation three years ago. B-ultrasound diagnosis was hysteromyoma, 3.5×3.6 cm. After taking the medicine for nearly two years, the situation has improved and the menstruation is normal. Do you need treatment now? What should we pay attention to in life?
Luo Lihua: The patient is approaching menopause. Because hysteromyoma is an estrogen-dependent tumor, it will gradually shrink with the decrease of estrogen level after menopause. Therefore, patients should go to the hospital regularly, and do not consider the problem of surgical treatment.
Moderator: Ms. Lin from Fujian, 34 years old. I have uterine fibroids. Married for ten years, no children. What should I do?
Zhang Yi: Patients must first find out the cause of infertility. If it is caused by hysteromyoma, it should be removed before pregnancy.
Moderator: Ms. Zhou from Guangzhou, 26 years old. Just pregnant for 2 months, I found myself with uterine fibroids. What should I do? Can uterine fibroids affect the development of the fetus?
Luo Lihua: Clinically, most patients with hysteromyoma complicated with pregnancy can safely go through the pregnancy process. However, it should be noted that patients with hysteromyoma complicated with pregnancy are prone to miscarriage, and hysteromyoma may also affect the blood supply to the uterus, and ischemic erythrodegeneration may cause nausea, vomiting, stomach pain and other symptoms. If the above symptoms appear, you must go to the hospital for examination. In addition, if fibroids grow into the uterine cavity, it is particularly easy to limit the child's development and cause fetal dislocation.
Moderator: Ms. Zhang, a 34-year-old Wuhan woman, had a hysterectomy. Will it affect her future husband and wife life? Will there be secretions?
Zhang Yi: Hysteromyomectomy should not affect sexual life and secretion.
Moderator: Ms. Bao from Hangzhou, 30 years old. I was diagnosed with hysteromyoma last year. I have been taking medicine for a while, and now I am pregnant for 6 months. Does it affect the fetus? Is it okay to have an operation at the same time when giving birth?
Luo Lihua: I have just answered the question about the influence of pregnancy on the fetus in patients with hysteromyoma. If fibroids do not affect delivery, vaginal delivery is recommended. If fibroids block the birth canal, caesarean section can be performed. The previous view does not advocate myomectomy during delivery, but if the patient has a large myoma, it is recommended to have surgery at the same time. Clinically, this operation does not produce too much blood as previously thought.
Moderator: Ms. Yan from Beijing is 50 years old this year. Three years ago, it was found that there were two fibroids the size of mung beans. There was no treatment at that time because there were no symptoms. Now it has entered menopause. What should I do? Is it necessary to remove it?
Zhang Yi: The patient's fibroids are very small and will gradually shrink after menopause. Don't worry too much.
Moderator: Ms. Yan, from Harbin, 47 years old. Uterine fibroids were detected last year. I checked again this year and found that they are growing very fast. What should I do? Need an operation?
Luo Lihua: The patient should be operated as soon as possible.
Moderator: Ms. Li from Jiangsu, 45 years old. I have had uterine fibroids for 5 years. I have been treated conservatively with traditional Chinese medicine. Because I still have lupus erythematosus, I can't be treated surgically. Now I'm going through menopause. Do I still need treatment?
Zhang Yi: Patients should be observed regularly. Some complications need surgery, and doctors should analyze them according to the condition.
Moderator: Ms. Fan, a native of Henan, is 27 years old. In May this year, uterine fibroids were found, about 5 cm. Married for half a year, no children. Will I get pregnant?
Luo Lihua: Myoma will not affect pregnancy, but if you can't get pregnant after one year, you can consider whether to have surgery.
Moderator: Outpatient time Zhang Yi Tuesday afternoon Luo Lihua Wednesday morning; Hospital telephone number (010) 65132266-612,6212.