Treatment of uterine fibroids

Content

  • Surgery
  • Conservative treatment



    Surgery

    Initially, should identify unconditional indications for surgical treatment:

    • submucosal myoma node localization
      • the large size of the uterus myoma modified (total value corresponds to the uterus 14 weeks of pregnancy)
      • uterine bleeding, accompanied by chronic hypochromic anemia
      • rapid tumor growth
      • acute impairment fibroids power (torsion subserous node legs, tumor necrosis)
      • the combination of uterine fibroids with recurrent or atypical hyperplasia of the endometrium, ovary tumor
      • compression of the ureter, the bladder, the rectum (intraligamentarnaya, retrotservikalnogo myoma node, located in predpuzyrnoy tissue)
      • myoma node availability in uterine tube angle, which is the cause of infertility
      • cervical and cervico-peresheechnaya localization
      • neregressiruyuschaya and increased uterine fibroids in postmenopausal age.

      The surgical procedure is largely determined by the patient's age.

      Treatment of uterine fibroidsUp to 40 years old with indications for surgical treatment, if technical possibilities allow produce conservative myomectomy (removal of fibroids with uterine preservation). It is especially advantageous to removeMacroscopic fibroids medium size (diameter of 2 to 5 cm), has not yet happened and frequently increase in size. The preferred technique is laparoscopic. When deciding on a conservative myomectomy should be taken into account morphotype tumor. When proliferating myoma can be removed several nodes, but further growth still many other rudiments growth. Therefore relapses when conservative myomectomy for uterine fibroids occur in 15-37% of cases.

      After 40 years of age and postmenopausal atthe availability of surgical indications require surgery removal of myoma of the uterus, as If fibroids are not regressed in the first 2 years of menopause, its further existence is accompanied by the danger of the emergence of cancer pathology (adenocarcinoma, sarcoma). Known domestic oncologist YV Bohman (1987) believed that neregressiruyuschaya uterine fibroids in postmenopausal period is a marker for cancer pathology of the reproductive system.


      Conservative treatment

      Conservative treatment is conducted inreproductive age, immediately after the detection of fibroids small and medium-sized can, in some cases, slow down the further growth of the tumor, to prevent operation to remove the uterus, retain the ability to have a child.

      Indications for conservative treatment:

      • the young age of the patient (reproductive and premenopausal)
      • the small size of the uterus myoma modified (10-12 weeks gestation)
      • intermuscular location of the fibroids
      • the relatively slow growth of fibroids
      • no deformation of the uterus (ie tsentripetalnogo growth and submucosal localization).

      The treatment is to normalize the systemviolations specific to patients with uterine myoma: chronic anemia, inflammation of the uterus and appendages, violation of blood supply to the pelvic organs with a predominance of venous stasis and decreased arterial blood supply, violation of the functional state of the nervous system and the autonomic balance.

      The methods of correction of system violations include the following:

      • adherence to a healthy lifestyle (normalization of sleep, a balanced diet, physical activity, avoiding harmful habits, control of body weight);
      • normalization of sexual activity;
      • periodic intake of vitamins and trace elements in the winter-spring period (gendevit, pentovit, Aevitum, folic acid);
      • anemia, volemic and metabolic disorders;
      • neurotrophic effects if the patient exhibits traits disharmonious personality.

      If you become pregnant, do not evenscheduled, you must preserve it, because postpartum uterine involution, breastfeeding the baby for at least 4-6 months help change histogenesis fibroids, its transition from proliferating in the simple and in some cases, termination of its further development.

      To prevent the imminent removal of the uterus during the growth of the tumor is of great importance to preserve and maintain the reproductive function of up to 40 years.

      The effectiveness of hormone therapy is veryIt varies depending on the nature of hormonal disturbances and the presence and density of receptors in the myometrium and myoma nodes. Recent predominate in non-durable existing fibroids small size, consisting mainly of smooth muscle cell component. In fibroma, where the stromal component prevails, and in large units hormone receptors are generally absent. Therefore, hormone therapy in these patients is not effective enough.

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