uterine fibroids
Introduction
Introduction to uterine fibroids Myomaofuterus, also known as uterine leiomyoma, is the most common benign tumor of the female genitalia. More asymptomatic, a small number of vaginal bleeding, abdominal mass and compression symptoms. Pain can occur if pedicle torsion or other conditions occur. Multiple uterine fibroids are common, the exact cause of this disease is unknown, modern western medicine adopts sex hormones or surgery, there is no other ideal therapy, uterine fibroids occur in women with 30-45 years old with ovarian function, after 50 years old Because of the obvious decline in ovarian function, most of the fibroids shrink. basic knowledge The proportion of illness: 0.02% Susceptible people: women Mode of infection: non-infectious Complications: irregular menstruation, more menstruation
Cause
Cause of uterine fibroids
Increased estrogen secretion (35%):
Estrogen secretion increased, accompanied by the onset of menopause, middle-aged women began to appear "estrogen control period." During this period, women themselves are more likely to develop depression due to the dual pressures of family and work, and promote the secretion of estrogen. In addition, long-term use of estrogen-containing contraceptives, slimming, whitening and other hormonal drugs and high hormone-contaminated food. These are all important causes of uterine fibroids. This is also an important cause of uterine fibroids.
Early menopause (25%):
The number of primordial follicles in a woman's life is limited, and the age of ovulation is about 30 years. During pregnancy and lactation, due to hormonal effects, the ovary is suspended for ovulation until the fourth to sixth months of lactation, and the ovary delays a certain number of ovulation, and women with a history of birth have to enter menopause later. Unfertile women are not protected by progesterone in a timely and effective manner, and are prone to hormone-dependent diseases. Uterine fibroids are one of them.
Sexual life disorders (15%):
Long-term sexual disorders, easily lead to hormone levels secretion disorder, leading to chronic congestion of the pelvic cavity, induced uterine fibroids.
Pathogenesis
1, generally
Uterine fibroids are solid tumors that can grow in any part of the uterus, individually or in large size, and even grow in tens to hundreds of fibroids. Generally, small fibroids are mostly spherical, but grow up or have multiple fibroids. When they fuse with each other, they become irregular shapes. The texture of fibroid tissue is harder than that of the uterus. Under direct vision, from the outside of the uterus, it is easy to touch the part where uterine fibroids exist. The fibroids have no capsule, and the fibroids are pressed around. The muscle wall fibers form a pseudo-envelope, and the boundaries are clear. There is a loose reticular gap between the fibroids and the uterine muscle wall. When the muscle wall is cut, the fibroids will jump out from the muscle wall, and it is easy to The pseudo-envelope exfoliates the fibroids. The blood supply of the fibroids is mostly from the pseudo-envelope. The surface of the fibroids is light, lustrous, and the cut surface is grayish white. The spiral or braided structure is visible and the arrangement is dense.
2, under the microscope
Uterine fibroids are mainly composed of fusiform smooth muscle cells and unequal fibrous connective tissue. The smooth muscle cells are evenly arranged in a fence or spiral structure. The longitudinal cells are fusiform, uniform in size, rod-shaped nucleus; transverse section cells. It is round, polygonal, and circular in the center. It is rich in cytoplasm. The content of smooth muscle cells and fibrous connective tissue in fibroids is related to the hardness of uterine fibroids. Submucosal fibroids protruding into the uterus are due to the endometrium. Mechanical compression, the inner membrane is thinned, the glands are flattened, close to each other, the glandular epithelium is cuboidal or flat, and the response during the secretory phase after ovulation is not obvious or the intimal defect is incomplete.
3, transgender
Mainly for various reasons caused by degenerative changes, the main cause of degenerative changes is due to insufficient blood supply to the local uterine fibroids, and has nothing to do with clinical symptoms.
(1) Various types of degeneration:
1 glassy change: glassy change, also known as hyaline degeneration, is the most common fibroid degeneration, fibroid tissue edema becomes soft, muscle fibers degenerate, spiral or braided structure disappears, merge into glass-like transparent body, due to glass More often occurs in the connective tissue of the fibroids, so the fibroids with more denaturation in the fibrous connective tissue are more obvious. Under the microscope, there are broadband transparent connective tissue in the fibroids, and regional cystic changes can occur. The necrosis of the tissue can be seen, and the tissue has no structure.
2 cystic changes: uterine fibroids glassy changes continue to develop, muscle cell liquefaction can occur cystic changes, at this time uterine fibroids become soft, difficult to distinguish from pregnant uterus or ovarian cysts, the size of the fibroids The cystic cavity, several cystic cavities can also be fused into a large cavity, with jelly-like and mucus-like substances accumulating, the inner layer of the cystic wall is covered with no epithelium, and the degeneration area of the cut surface is cotton-like, varying in size, and the cystic sac fluid It is divided into colorless or bloody. Under the microscope, the cystic zone is stained with a pale blue cloud. It can also be seen that there are small clusters of muscle cells remaining, and there may be myocyte proliferation around the myocytes.
3 red degeneration: more common in pregnancy or postpartum, red degeneration is a special type of necrosis of fibroids, the mechanism is unclear, may be the degeneration of small blood vessels in the fibroids, causing thrombosis or hemolysis, hemoglobin infiltration into the muscle Inside the tumor, the cut surface is dark red, such as semi-ripe beef, which has a stenchy smell, soft texture, and the vortex-like structure disappears. The tissue is highly edematous under the microscope. The small veins in the tumor have thrombosis, vasodilatation and hyperemia, extensive hemorrhage and hemolysis, muscle. The cytoplasm is lightly stained, the outline is unclear, the muscle cells are reduced, the nucleus often dissolves and disappears, and there are more fat globules deposited.
4 steatosis: the general lesions are small, a small number of fat granules can be seen, mainly the increase of fat granules in the myoma cells. Under the microscope, there are vacuoles in the muscle cells, and the fat staining is positive. The reason may be the interstitialization of the fibroids. It is adipose tissue, and it may also be adipose tissue infiltration. When all the fibroids become yellow fat, they are called lipomas, but they are extremely rare.
5 calcification: more common in the subserosal fibroids with insufficient blood supply in the pedicle and fibroids in postmenopausal women, more common in saponification after fatty degeneration, decomposition into triglycerides, and then combined with calcium salts, so fibrosis of fibroids is It is deposited in the fibroids in the form of phosphoric acid and phosphate. It is as hard as a stone. The calcification shadow can be clearly seen on the X-ray film. The calcified area is layered and deposited in a circular shape with dark blue fine particles.
6 infection and suppuration: uterine fibroid infection is more common in submucosal fibroids out of the uterus or vaginal opening, subserosal fibroid infection is seen in blood-borne or adjacent organ infection spread, myometrial fibroid infection is more common in cystic degeneration After the submucosal fibroids infection with local necrosis, ulcers and mucosal shedding, bacteria retrograde into the uterine cavity and endometritis, salpingitis combined.
7 malignant transformation: malignant transformation of fibroids is mainly sarcomatoid, the incidence rate is 0.4% to 1.25%, sarcomatoid changes are more common in intermuscular fibroids, more women in 40 to 50 years old, less common in children under 30 years old, fibroids If you grow up quickly or have irregular bleeding in the short term, you should first consider malignant transformation. After the malignant transformation of the myoma, the tissue becomes soft and brittle. The cut surface is grayish yellow, delicate, like raw fish, and the boundary with the surrounding tissue is unclear. Visible smooth muscle cell proliferation, disordered arrangement, vortex-like structure disappeared, cells have atypical.
(2) clinical type: uterine fibroids can occur in any part of the uterus, according to the location of the fibroids can be divided into uterine fibroids and cervical fibroids, the former accounted for about 90% to 96% of uterine fibroids, the latter only accounted for 2.2% to 8%, the cervical and uterine body at the same time fibroids accounted for 1.8% (Lian Lijuan, 2000; Zhang Xiyin, 1992), uterine fibroids are only formed by a single tumor cell in the muscle wall, followed by The enlargement of fibroids gradually grows from different directions in the uterine muscle wall, and is divided into three categories according to their relationship with the uterine muscle wall:
1 intermuscular fibroids: intramural myoma (intramural myoma), also known as myometrial intramuscular fibroids, fibroids located in the myometrium, surrounded by normal muscle layer, the boundary between fibroids and muscle wall is clear The uterine muscle wall that is squeezed around the fibroids is often called the pseudo-envelope. These fibroids are the most common, accounting for 60% to 70% of the total number of fibroids. The fibroids are often single or multiple, varying in size. The small ones, such as rice or soybeans, do not change the shape of the uterus; the larger ones can enlarge the uterus or change the shape of the uterus into irregular protrusions, often with the uterine cavity deformed.
2 subserosal fibroids: subserous myoma (subserous myoma) when the myometrial fibroids grow to the serosal layer of the uterine surface, so that the surface of the fibroids only covered a little muscle wall and serosal layer called pulp Submembrane fibroids, when the fibroids continue to grow under the serosa, forming a pedunculated myoma with a pedicle connected to the uterine wall, the fibroids grow on both sides of the uterus and go to the two uterus The growth of the lateral ligament is called intraligamentary myoma. These fibroids can often compress nearby ureters, bladder and iliac vessels and cause corresponding symptoms and signs. The subserosal fibroids can be reversed due to The blood supply is blocked, the fibroids rupture and fall off in the pelvic and abdominal cavity, and the tumor is necrotic. If the exfoliated fibroids are stuck with adjacent organs such as the omentum, mesentery, etc., and the blood supply is obtained, the growth is called parasitic fibroids. Parasitic myoma), or migratory fibroids, subserosal fibroids accounted for 20% to 30% of the total number of fibroids, due to extrafisity of the fibroids, the uterus is enlarged, the shape is irregular, the surface is uneven, nodular, with Subserosal fibroids can be in any part of the uterus And, as a solid tumor can be active, broad ligament fibroids in the uterus next touch, activity limitation.
3 submucosal fibroids: submucous myoma (submucous myoma) close to the intrauterine myometrial fibroids, grow in the direction of the uterine cavity, the surface covered with endometrium called submucosal fibroids, this fibroids prominent In the uterine cavity, the shape of the uterine cavity can be changed. Some fibroids are only connected with the uterine wall and are called submucosal fibroids. This kind of fibroid causes reflex uterine contraction in the uterine cavity as a foreign body. Due to gravity, The fibroids gradually move down to the inner cervix, and finally the pedicle is elongated. The fibroids are gradually pushed to the external cervix or vaginal opening. These fibroids account for about 10% of the total. Because the fibroids are located in the uterine cavity, the uterus is more For the consistency of growth, due to the traction of the fibroids and the lack of blood supply to the fibroids, the uterus may have mild varus and endometrial hemorrhage, necrosis, infection and irregular vaginal bleeding and increased secretions. There are often multiple uterine fibroids. The above fibroids can be caused by two or even three kinds of simultaneous uterine fibroids.
Cervical fibroids can grow in the anterior or posterior lip of the cervix. Cervical fibroids can form pedicled cervical fibroids in the cervical canal. Muscles of the cervical muscle wall can grow up with the fibroids, so that the cervix can be pulled. Long, or protruding into the vaginal or incarcerated pelvic cavity, at this time the normal size of the uterus is located on the huge cervix, pushing the uterus or bladder to the lower abdomen, and anatomical relationship between the pelvic anatomy on both sides, increased surgery The degree of danger.
Prevention
Uterine fibroid prevention
Prevention :
1. Participate in the gynecological census for early detection and early treatment.
2, patients with uterine fibroids should do a good job of contraception, once pregnant, it will bring some difficulty to abortion surgery, easy bleeding.
3, Chinese medicine treatment of uterine fibroids should be regularly performed gynecological examination and B-ultrasound examination to understand the changes in uterine fibroids, if the following conditions are found, surgery should be done:
(1) There are obvious symptoms, especially those with more menorrhagia or abdominal pain.
(2) uterine fibroids rapidly increase, or more than 3 months pregnant uterus.
(3) uterine fibroids with transgender.
(4) Uterine fibroids are located in the uterine neck or protrude from the vagina.
4, the treatment of uterine fibroids combined with pregnancy
(1) During pregnancy, under strict observation, attention should be paid to prevention of abortion or premature birth. If the fibroids are too large, it is estimated that it is difficult to continue pregnancy, and surgery should be performed early.
(2) Care should be taken during childbirth to avoid abnormal fetal position, delayed labor and placental retention. For example, fibroids obstructing the birth canal dam must be used for cesarean section.
(3) Pay attention to prevent bleeding and infection after childbirth.
Easy to send people:
Compared with more than a decade ago, uterine fibroids are increasingly favoring middle-aged women in their 30s and 40s, especially the three types of women, such as unfertile, sexually dysfunctional and dysfunctional depression. Gynecologists introduce the specific causes of uterine fibroids. At present, it is not very clear, but studies have shown that hormone secretion is too strong, which is the most common cause of uterine fibroids, and these three behavioral patterns of women are the main culprit causing endocrine disorders, leading to excessive hormone secretion.
Category 1: Infertile women enter menopause in advance
The number of primordial follicles in a woman's life is limited, and the ovulation period is about 30 years. During pregnancy and lactation, due to hormonal effects, the ovary is suspended for ovulation until the 4th to 6th month of lactation, and the ovary is delayed by a certain amount. Ovulation, women with a history of birth should enter the menopause later, and unfertile women can not get timely and effective protection of progesterone, prone to hormone-dependent diseases, uterine fibroids is one of them, authoritative research shows that if women have a lifetime A complete gestation process can increase immunity for 10 years, and this 10 years of immunity is mainly for gynecological tumors.
Category 2: Sexual life disorders affect uterine health
Traditional Chinese medicine says that uterine fibroids belong to the category of "symptoms" (causes in the stomach), and the formation of "symptoms" is mostly related to qi deficiency and qi and blood disorders. Chinese medicine explains "symptoms": women are The temperament, the husband and wife do not, will inevitably hurt the seven emotions, seven emotions, internal injuries, poor air, qi and blood disorders, qi stagnation and blood stasis, deposition for a long time, it can be "symptoms", visible, normal between husband and wife Sexual life stimulation can promote the normal operation of neuroendocrine, so that the human hormones are normally and well secreted, and long-term sexual disorders are easy to cause hormone level secretion disorder, leading to chronic congestion of the pelvis and induction of uterine fibroids.
Category 3: Multiple uterine fibroids in depressed women
Middle-aged women face the dual stress of work and family, and are prone to depression. With the arrival of menopause, women begin to have an "estrogen control period". During this period, women's own depression is easy to promote. Estrogen secretion increases, and the effect is enhanced, sometimes for months or even years, which is also an important cause of uterine fibroids.
When Chinese medicine talks about the influence of emotion on uterine fibroids, it is mentioned: "Qi stagnation, internal sensation of internal sensation, loss of liver and blood stasis, blood stasis is not stagnation in the uterus, and it is manifested as lower abdomen, which can be moved and painless. At the time of gathering, the spirit is depressed, the chest is full, and this is also the reason.
Family control
1, the home of treatment of uterine fibroids:
(1) According to the doctor's prescription, oral uterine fibroids, 3 times a day, 15 grams each time, and even served for three months to observe the effect.
(2) Take the king without leaving 100 grams, Prunella vulgaris, raw oysters, 30 grams of Suzi, Shuijianbi, daily or every other day, 30 doses for a course of treatment.
(3) If menstruation is more, under the guidance of a doctor, intramuscular injection of testosterone propionate 25 mg twice a week for a total of 8 treatments.
2, should pay attention to after suffering from uterine fibroids:
(1) Prevent excessive fatigue, especially during the menstrual period.
(2) Eat more vegetables, fruits, and eat less spicy food.
(3) Keep the vulva clean and dry, and the underwear should be wide. If the leucorrhea is too much, you should pay attention to flushing the vulva at any time.
(4) After diagnosis of uterine fibroids, you should go to the hospital every month to check: times, if the fibroids increase slowly or never increase, you can review it once every six months; if the enlargement is obvious, you should consider surgical treatment to avoid serious bleeding. Or oppress the abdominal organs.
(5) to avoid re-pregnancy, women with uterine fibroids after abortion, poor recovery of the uterus, often cause long-term bleeding or chronic genital inflammation.
(6) If the amount of menstruation is too much, eat more iron-rich foods to prevent iron deficiency anemia.
(7) Do not take extra estrogen, especially after menopause, so as not to grow uterine fibroids.
(8) If you need to retain fertility and must be treated surgically, you can use myomectomy.
3. Life care
(1) Diet:
1 motherwort 50 ~ 100 grams, dried tangerine peel 9 grams, 2 eggs, add some water to cook, egg cooked after shelling, and then cook for a while, eat egg soup, 1 time before menstruation, and even served several times.
2 yuan Hu, Ai Ye, Angelica 9 grams, 60 grams of lean pork, a little salt, add 3 bowls of the first 3 flavors, fry into a bowl, go to the dregs, then cook in pork, season with salt, before menstruation 1 dose per day, and even take 5 to 6 doses.
(2) Blood stasis syndrome
Performance: The abdomen is hard and fixed, the pain is refused, the menstrual volume is more, the menstrual period is prolonged, the color is dark, or the complexion is dull, the breast has agglomeration, the dark side of the tongue has a defect, the freckle, the pulse astringent.
Chinese patent medicine: Guizhi Fuling Pills, 6 grams each time, 2 times a day, warm yellow wine delivery service, the above 2 kinds of medicines, the period is suspended.
Diet:
1 unhatched chicken (duck) eggs 4, ginger 15 grams, rice wine 50 ml, first with chicken (duck) eggs shelled, hair and internal organs, add yellow wine, ginger cooked, seasoned after serving Food, 1 dose per day before menstruation, and even served for several days.
2 loofah seeds 9 grams, the amount of brown sugar, a little yellow wine, roast the loofah seeds, decoction juice, add yellow wine, brown sugar transfer, 1 time before menstruation, and even served for 3 to 5 days.
(3) Dampness certificate
Performance: lower abdomen mass, faint pain, according to the soft, with a lot of color, white and sticky, chest tightness, cold, body fat, dark purple tongue, greasy tongue coating, fine pulse.
Chinese patent medicine: 1 Liujunzi pills, 6 to 9 grams per pill, 2 to 3 times a day, warm water to send clothes.
2 Shenqi Baizhu Pills, 6 grams each time, 2 times a day, fasting jujube decoction or warm boiled water delivery service.
Diet:
1 Atractylodes 250 grams, 250 grams of Atractylodes, 250 grams of sputum, 150 grams of ginger, 100 jujubes, the first 3 flavors washed and dried, finely sifted, jujube to nuclear, ginger into mud and then to ginger residue, Ginger jujube mud blending powder is a paste, antiseptic storage and reserve, 30 grams each morning and evening, rice wine delivery service.
2 Rengen 30 grams, 30 grams of old loofah (fresh), decoction juice, add a little brown sugar to taste, take 1 day, even for 5 days
(4) ruminant eggs
2 eggs, 5 Chinese medicine geckos, 9 grams of scorpion, 400 grams of water to cook together, after the eggs are cooked, peeled and then boiled, discarded medicine eggs, served once a night, efficacy: Sanjie pain, hurricane fixed shock, suitable Gas stagnation blood stasis type.
(5) two fresh soup
120 grams of fresh scallions, 120 grams of fresh roots chopped, boiled juice with tea.
Efficacy: nourishing yin and cooling blood, phlegm and stasis to stop bleeding, suitable for menstrual flow, blood heat and stasis.
(6) Tremella powder soup
25 grams of white fungus, 10 grams of glutinous rice powder, the right amount of crystal sugar, the white fungus foamed, add the right amount of rock sugar stew, smashed into the powder.
Efficacy: It has the effect of clearing heat and moistening dryness and stopping bleeding. It is suitable for menstrual flow and red blood.
Family self-treatment
1, massage
The patient is lying on his back, and the operator stands next to him, using his thumb to press the sacred scorpion, Qihai, Guanyuan, Tianshu, Sihai, return, uterus, Qichong, Xuehai, Sanyinjiao, 1 minute per hole, then After rubbing with the palm of your hand, place the small abdomen, and after 36 turns in the clockwise direction, change the counterclockwise direction to 36 times of the abdomen. Finally, push the lower back 10 to 15 times with the palm of your hand, to soreness. Massage once a day, 10 times for the course of treatment, stop the massage during menstruation.
2, application method
1 15 grams of sclerotium, 15 grams of live, 15 grams of white peony, 20 grams of armor, 15 grams of trigonal, 15 grams of medlar, 20 grams of salvia, 15 grams of safflower, 15 grams of red peony, a total of coarse rolled, loaded After the bag is steamed hot and warmed to the lower abdomen, 1 to 2 times a day, each time 20 to 30 minutes, each package can be used continuously for 5 to 7 times, 10 days for a course of treatment, menstruation is suspended.
21, 10 grams of Clematis, respectively, roast the powder, use the right amount of yellow wine to adjust the umbilical, plaster paste, 1 time a day, each time about 1 hour, the menstruation is suspended.
3 South Star, 15 grams of white mustard, Magnolia, Pinellia, 12 grams of oyster shell, white peony, 10 grams of wormwood, 6 grams of scallion, a total of research and coarse, sprayed into the bag, sprayed, steamed for half an hour, Hot ironing under the umbilicus, once a day for 20 minutes each time, each dose can be used continuously for 5 to 7 days, 10 times for a course of treatment.
4 Pinellia 10 grams, 6 grams of scallion, a total of mud, applied to the umbilical covered with wound cream, 1 daily change, 5 days for a course of treatment.
Life tips
When uterine fibroids compress the surrounding organs, it is advisable to perform surgical removal of fibroids. For those under 40 years old, with more bleeding and anemia and other complications, surgery can be considered (only for women who are no longer born), and the age is greater than 45-year-olds should be treated conservatively. After menopause, they will be cured (hemorrhage stops). During the menstrual period, the drugs for promoting blood circulation and removing blood stasis should be used with caution to prevent the increase of blood loss. The diet should also be based on light diet, fasting and spicy. Explosive products, and appropriate rest, for the amount of bleeding, acute blood loss, dizziness, palpitations, pale, should be treated in hospital to prevent hemorrhagic shock.
Postoperative maintenance
First of all, to determine the surgical nature of the patient, is the uterine fibroids removal surgery, or the total hysterectomy, the general uterine fibroids patients come over menopause, are even the uterus and uterus full cut, if the former, the fibroids are removed, Then there is no difference with caesarean section surgery, the wound surface is small, the bleeding is less, and the relative recovery is easy. If it is the latter, then it belongs to the myomectomy and organ removal, the relative wound and the amount of bleeding are larger than the former, and the general recovery period is 1-2. Between months, the method of cultivation is similar to that of confinement. Many patients have to be clear about their mothers. As long as they are not tired from the cold, they should rest quietly. In addition, the surgical incision of uterine fibroids is very special. Note that it is in the navel. In the next three inches, the transverse incision is not vertical, so it is easier to recover than other operations. One or two days after the operation, especially in the evening, it is more difficult for the family to care more. In addition, according to personal circumstances, If you keep the uterus, and the patient is still not menopausal, then continue to take half a year of drug control menstruation, the postoperative patients will generally be all-round Or back pain, but as long as peace and quiet are not big problems, when people are sick of family care of the most important ah.
Complication
Uterine fibroid complications Complications, irregular menstruation, menorrhagia
Uterine fibroids grow slowly and have no pain. Once the clinical symptoms of pain are caused by complications of fibroids, some patients come to the hospital for pain because of their initial pain. They should combine their clinical symptoms and signs to find out the cause and the complications of fibroids. Symptoms have red degeneration, infection, and reversal.
1, red denaturation
Red degeneration of uterine fibroids is more common in pregnancy or postpartum, and can also occur in menopausal women. The naked eye has a dark red, dull, soft, and deteriorated beef. It occurs mostly in the second trimester. Tumor is common, patients with severe abdominal pain, with fever, generally around 38 ° C, white blood cells increased, check the tumor local obvious tenderness, generally symptomatic treatment, the symptoms gradually improved, about 1 week to recover, no surgery, However, sometimes the symptoms of ischemia and necrosis are aggravated, symptomatic treatment is ineffective, or other possibilities may not be ruled out. Finally, laparotomy should be performed for uterine myomectomy. Generally, no resection of myoma is recommended during pregnancy because of the risk of abortion. At the same time, the operation is also prone to bleeding. If it occurs in non-pregnant women, the clinical process is mild, usually not so sharp, the symptoms last for 1 to 2 days or continue to increase, there are indications for laparotomy, depending on the situation, the fibroids are determined according to the situation. Resection or hysterectomy.
2, infection
Uterine fibroid infection mostly occurs in the submucosal fibroids of the uterus or the submucosal fibroids of the cervix. Because of the infection of the pathogenic bacteria in the vagina, once infected, there is a large amount of vaginal discharge, mixed with blood or purulent. Smell, check the surface of the fibroids edema, covered with white or necrotic tissue, grayish black, and even rotted tissue shedding, the tumor touches soft, the cervix is soft, the iliac soft, the uterus is normal if there is no other tumor , can be active, both sides of the uterine tissue soft, no tenderness, submucosal fibroids infection is generally fluent, rarely pelvic inflammatory disease, and even cause clinical fever, abdominal pain and other systemic symptoms, subserosal fibroids due to red denaturation or twist Nervous necrosis or intramuscular fibroid cystic changes cause necrosis in the central part of the tumor. When secondary infection occurs, the patient presents with acute abdominal pain, fever, gynecological examination of fibroids with tenderness, active treatment of infection, and surgical treatment.
3, reverse
The uterine fibroids reversal mainly occurs in subserosal fibroids. Generally, the fibroids are short and thick. Although they can be reversed, their incidence is far less common than that of ovarian cysts. Occasionally, giant subserosal uterine fibroids Can be complicated by uterine torsion, the patient has a sudden lower abdominal pain after twisting the pedicle, and the pain is broken. If the tumor is invaded in the pelvic cavity after twisting, there may be a feeling of lower abdomen, and the lower abdomen may touch the mass, and there is tenderness and the most tenderness. Obviously in the pedicle of the uterus, the vaginal examination of the uterus is normal or enlarged, the surface of the uterus can be touched with tenderness, sometimes the side of the uterus is biased to the uterus and the ovarian tumor is difficult to identify, and the B-ultrasound can help distinguish The source of the tumor is generally no fever. If there is a secondary infection for a long time, there may be fever. Once diagnosed, surgery is needed.
Symptom
Symptoms of uterine fibroids Common symptoms Lower abdominal mass return to intermenstrual bleeding Menstrual flow more painful lower abdominal pain Frequent urination
1, symptoms
More no obvious symptoms, only found in the pelvic examination. Symptoms are closely related to fibroids, growth rate and fibroid degeneration, and have little to do with the size and number of fibroids.
(1) Menstrual changes: the most common symptoms. Large intermuscular fibroids increase the uterine cavity and intimal area, poor uterine contraction or excessive endometrial hyperplasia, resulting in shortened cycle, increased menstrual flow, prolonged menstruation, irregular vaginal bleeding. Submucosal fibroids are often menorrhagia, with the enlargement of the fibroids and prolonged menstruation. Once the fibroids are necrotic, ulcerated, or infected, there is persistent or irregular vaginal bleeding or pus and bloody drainage. Subserosal fibroids and intermuscular fibroids often have no obvious menstrual changes.
(2) Abdominal block: The patient often complains that the abdomen is swollen, and the lower abdomen is in the middle of the sputum and the block. When the bladder is filled in the morning, the uterus is pushed upwards, and the texture is hard and the shape is irregular.
(3) increased vaginal discharge: intermuscular fibroids make the uterine cavity area increase, endometrial gland secretion increased, accompanied by pelvic congestion resulting in increased vaginal discharge; submucosal fibroids suspended in the vagina, the surface is susceptible to infection, Necrosis, a large amount of pus and bloody discharge and rotten meat-like tissue discharge, accompanied by odor.
(4) Abdominal pain, backache, lower abdomen bulge: The patient usually has no abdominal pain, and acute abdominal pain occurs when the subserosal fibroids are twisted. When the fibroids are red, the abdominal pain is severe and accompanied by fever. Lower abdomen bulge, back pain are common, and menstruation is aggravated.
(5) Symptoms of compression: fibroids compress the bladder with frequent urination, dysuria, and urinary retention. Compression of the ureter can cause hydronephrosis. Pressing the rectum can cause difficulty in defecation.
(6) Infertility: The literature reports account for 25% to 40%. It may be that the fibroids press the fallopian tube to distort it, or deform the uterine cavity, preventing the implantation of the fertilized egg.
(7) Secondary anemia: long-term menorrhagia leads to secondary anemia. In severe cases, there are symptoms such as general weakness, pale complexion, shortness of breath, and palpitations.
2, signs
It is related to the size, location, number of fibroids and the presence or absence of degeneration. The fibroids are larger in the abdomen and hard, irregular, nodular masses. During gynecological examination, the uterus of the intermuscular wall is often enlarged, the surface is irregular, single or multiple nodular protrusions; the subserosal fibroids can be hard and hard, the globular mass is connected with the uterus, and the activity; The submucosal fibroids are mostly enlarged, sometimes the cervix is dilated. The fibroids are located in the cervix or in the vagina. They are red, parenchy, smooth, and the surface is covered with exudate or ulceration. Stinks.
Examine
Examination of uterine fibroids
Diagnostic curettage is the most convenient and convenient diagnostic method for gynecology. Exploring the situation of the uterine cavity and scraping the endometrium for pathological examination is the basic requirement. When the diagnostic curettage is performed, the depth, direction and deformation of the uterine cavity are explored. And submucosal fibroids, assisted vaginal examination to determine the location of the fibroids and its effect on the uterine cavity, the anterior wall fibroids protrude into the uterine cavity when the uterus probe enters the direction first, and vice versa if the fibroids from the posterior wall are probes Entering forward, there is a sense of climbing when advancing, and the protrusion can reach the bottom of the palace. When the curettage should be performed, it should be understood whether the wall is smooth, whether there is protrusion or swelling at the bottom of the palace, but the small submucosa is easily slipped. Missed diagnosis, this is the diagnosis of curettage, the giant cervical muscle tumor is stretched, up to 10cm, the uterus is lifted, although the size of the uterus is unchanged, sometimes the probe must enter 15cm to reach the end of the palace, This kind of uterine fibroids is not easy to explore the uterine cavity. It requires a doctor with some experience to operate. The side-by-side analysis can get the correct judgment. Another requirement for diagnostic curettage is to understand the pathological properties of the endometrium, for young women. Endometrial cancer is often in the routine diagnostic curettage found, therefore, should be classified as routine diagnostic curettage of uterine fibroids before surgery.
1, ultrasound examination
At present, domestic B-ultrasound examination is more common, the identification of fibroids, the accuracy rate of up to 93.1%, it can show uterine enlargement, irregular shape; number of fibroids, location, size and uniformity within the fibroids or liquefaction cystic; Whether there are other organs and other manifestations around the tumor, because the cell volume in the unit volume of the tumor cells in the myoma nodules is dense, the content of the connective tissue scaffold structure and the tumor, the cell arrangement is different, and the fibroid nodules are weak echoes when scanned. There are three basic changes in echo and strong echo. The weak echo type is cell density, elastic fiber content, cell nesting, blood vessels are relatively abundant, strong echo type, collagen fiber content, tumor cells in bundle Mainly arranged, the echogenic type is between the two, the posterior wall fibroids, sometimes unclear, the harder the fibroids, the more severe the attenuation, the benign attenuation is more obvious than the malignant, and the acoustic penetration is enhanced when the fibroids are degenerated. The necrotic area increases during malignant transformation, and the echo within it is disordered. Therefore, B-ultrasound can help to diagnose fibroids, provide a reference for distinguishing whether fibroids are degenerated or have malignant changes, and help ovarian tumors or other pelvic cavity. Identification of the mass.
2, detecting the uterine cavity
The probe is used to measure the uterine cavity. The interstitial fibroids or submucosal fibroids often enlarge and deform the uterine cavity. Therefore, the size and direction of the uterine cavity can be detected by the uterine probe. See the double-close clinic to help determine the mass. Nature, at the same time can understand the presence or absence of mass in the cavity and its location, but must pay attention to the uterine cavity often tends to bend back, or blocked by submucosal fibroids, so that the probe can not fully penetrate, or subserosal fibroids, Palace The cavity often does not increase, but causes misdiagnosis.
3, X-ray film
When the fibroids are calcified, they appear as scattered spots, or shell-like calcified envelopes, or honeycombs with rough edges and wavy edges.
4, diagnostic curettage
Small submucosal fibroids or dysfunctional uterine bleeding, endometrial polyps are not easy to use for double diagnosis, can be used to assist diagnosis by curettage, such as submucosal fibroids, curettes have a convex surface in the uterine cavity, After starting to rise, it will slide down, or feel that something is sliding in the uterine cavity, but the curettage can scrape the tumor surface and cause bleeding, infection, necrosis, and even sepsis. It should be strictly aseptic, gentle, and the scraping should be sent to the pathology. Examination, suspected submucosal fibroids and the diagnosis is still not clear, uterine angiography can be used.
5, hysterosalpingography
Ideal uterine angiography can not only show the number, size, and location of submucosal fibroids, therefore, it is very helpful for the early diagnosis of submucosal fibroids, and the method is simple, and the angiogram of the fibroids shows intrauterine There are fillings and defects.
6, hysteroscopy
Uterine fibroids are generally difficult to diagnose. Usually, the clinical difficulty is small submucosal fibroids. Diagnostic curettage is often missed. In the postoperative hysterectomy specimens, submucosal uterine fibroids are found. Hysteroscopy can be Observing the nature of intrauterine lesions under direct vision, determining the lesion site and accurately taking biopsy, can also be removed at the same time for small submucosal fibroids.
7, laparoscopy
With the wide application of laparoscopic techniques in obstetrics and gynecology, laparoscopic surgery is not only used as an examination method, but also often concurrent with surgery, and is increasingly valued. Uterine fibroids can be clinically examined and generally do not require laparoscopy, some pelvic If the tumor has surgical indications, it can be directly exploratory laparotomy. Occasionally, the solid small mass found by the uterus is difficult to determine its source and nature, and its treatment methods are different. Especially when B-ultrasound is difficult to determine, it can be used for laparoscopy. Diagnosis for treatment, such as small subserosal fibroids, ovarian tumors, tuberculous accessory masses, etc. Laparoscopy should carefully observe the size and location of pelvic fibroids, and the relationship with the surrounding organs, the surgeon can immediately perform surgery Treatment, therefore, must be prepared for any surgery that may be performed immediately after the decision to perform a laparoscopy.
8, CT and MRI
These two checks are generally not required.
The CT diagnosis of fibroids only expresses the details in a specific level, and the image structures do not overlap each other. The CT image of benign uterine tumors is enlarged in volume and uniform in structure, with a density of +40 to +60H (normal uterus is +40~). +50H).
When MRI diagnoses fibroids, there is no degeneration inside the fibroids, and the types and extents show different signals. The muscle nucleus has no degeneration or mild degeneration, and the internal signals are more uniform. Conversely, the obvious transgenders have different signals.
Diagnosis
Diagnosis and diagnosis of uterine fibroids
diagnosis
Diagnostic criteria for uterine fibroids:
1, menorrhagia, prolonged or irregular bleeding, the lower abdomen can appear lumps, a few have pain and compression symptoms, or with pelvic blood.
2, the uterus is enlarged, hard.
3. Detecting the growth or deformation of the uterine cavity.
4. The convex surface is touched in the uterine cavity during the diagnosis.
5, B-mode ultrasound and / or hysteroscopy can help diagnose.
Differential diagnosis
The diagnosis of uterine fibroids is generally not difficult. Sometimes, because the medical history is unclear or the signs are not typical, it will bring certain difficulties to the diagnosis. The main point of differential diagnosis is to grasp the characteristics of each disease and combine the obtained medical history with the test results. Careful analysis, making identification.
1, intrauterine pregnancy
In the first 3 months of pregnancy, some pregnant women still have a small amount of bleeding per month. If they mistakenly believe that menstruation is normal and the uterus is enlarged, they are often misdiagnosed as fibroids. The history of menstruation (including the amount) should be questioned in detail. Birth history, age (older fibroids have fewer chances); should also pay attention to whether there is pregnancy reaction, such as pregnancy, uterus enlargement meets the month of menstrual reduction; fibroids uterus is hard, in addition to pregnancy vulva, vagina Purple blue, soft cervix, breast sensation, secondary halo outside the areola, after 4 months of pregnancy, can feel fetal movement or hear fetal heart sounds, can be felt by hand to detect uterine contractions, in addition to medical history, physical signs It can also be used for pregnancy test or B-ultrasound examination to identify.
Expired abortion with irregular vaginal bleeding, urine pregnancy test is negative, easy to be misdiagnosed as uterine fibroids, but expired abortion has a history of menopause, had a pregnancy reaction, normal uterine morphology, B-ultrasound, generally can be diagnosed, necessary When the diagnosis is feasible.
Uterine fibroids can be combined with pregnancy, but also must be thought of, otherwise missed pregnancy or misdiagnosed as hydatidiform mole, in the past, if you have found fibroids, there are now early pregnancy history and signs, and the uterus is greater than menopause months, no vaginal bleeding, pregnancy test positive If there is no difficulty in diagnosis, but in the past, if you have not been diagnosed, you should ask in detail whether there is too much menstruation, whether there is a history of infertility, and pay attention to the presence or absence of fibroids in the uterus. If necessary, observe closely. If it is a mole, stop it. After a small amount of vaginal bleeding, the abdominal mass grows in a short period of time, the pregnancy test is positive and the titer is high; B-mode ultrasound examination of the mole is a snow-like characteristic wave pattern.
2, ovarian tumor
Ovarian cysts are not easy to be confused with uterine fibroids, because the hardness of the two is different, the former is cystic and the latter is solid, while the former has a boundary with the uterus, which can be separated from it, while the uterine fibroids are closely related to the uterus. Separately, the movement of the cervix is followed by activities. The diagnosis of more difficult ovarian solid tumors and subserosal uterine fibroids, both of which are solid masses, if the fibroids are on one side of the uterus, especially with pedicles. Subserosal fibroids are sometimes difficult to identify, and must be assisted by B-ultrasound. The ovarian malignant tumor is also a solid mass. When it is firmly bonded to the uterus and melts into a mass, it is a uterus outside the tumor but cannot be separated.BB
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