Uterine fibroids are the most common benign tumors in female reproductive organs and one of the most common tumors in the human body. They are also called fibroids and uterine fibroids. Because uterine fibroids are mainly formed by the proliferation of uterine smooth muscle cells, and a small amount of fibrous connective tissue exists as a kind of supporting tissue, it is more accurate to call uterine leiomyomas. Referred to as uterine fibroids.
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Cause
The etiology of uterine fibroids is still not very clear. It may involve more complicated interactions among normal muscle layer cell mutations, sex hormones and local growth factors.
According to a large number of clinical observations and experimental results, uterine fibroids are a hormone-dependent tumor. Estrogen is the main factor that promotes the growth of fibroids. Some scholars believe that growth hormone (GH) is also related to the growth of fibroids. GH can cooperate with estrogen to promote mitosis and promote the growth of fibroids. It is speculated that human placental prolactin (HPL) is also It can synergize the mitogenic effect of estrogen. It is believed that the accelerated growth of uterine fibroids during pregnancy is related to the high hormone environment during pregnancy, and HPL may also participate in the role.
In addition, ovarian function and hormone metabolism are controlled and regulated by the advanced nerve center, so the nerve center activity may also play an important role in the pathogenesis of fibroids. Factor uterine fibroids are more common in women of childbearing age, widowhood and uncoordinated sexual life. Chronic pelvic congestion caused by long-term sexual imbalance may also be one of the causes of uterine fibroids.
In short, the occurrence and development of uterine fibroids may be the result of multiple factors.
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Clinical manifestations
1. Symptoms
Most patients are asymptomatic and are only found occasionally during pelvic examination or ultrasound examination. If there are symptoms, it is closely related to the growth location, speed, presence or absence of fibroids and complications, while the relationship with the size and number of fibroids is relatively small. People with multiple subserosal fibroids may not have symptoms, and a smaller submucosal fibroids can often cause irregular vaginal bleeding or menorrhagia. Common clinical symptoms are:
(1) Uterine bleeding is the most important symptom of uterine fibroids, which occurs in more than half of patients. Among them, cyclical bleeding is more common, which can be manifested as increased menstrual volume, prolonged menstrual period, or shortened cycle. It can also manifest as irregular vaginal bleeding without menstrual cycles. Uterine bleeding is more common in submucosal fibroids and intramural fibroids, while subserosal fibroids rarely cause uterine bleeding.
(2) Abdominal mass and compression symptoms. Myoma gradually grows. When it increases the size of the uterus for more than 3 months of pregnancy, or is a large subserosal fibroids located at the bottom of the uterus, the mass can often be palpated in the abdomen , It is more obvious when the bladder is full in the morning. The mass is solid, movable, and non-tender. When fibroids grow to a certain size, they can cause symptoms of compression of surrounding organs. Those with anterior uterine fibroids close to the bladder can cause frequent urination and urgency; huge cervical fibroids compressing the bladder can cause poor urination and even urinary retention; posterior uterine fibroids are particularly Isthmus or posterior lip myoma of the cervix can compress the rectum, causing unsmooth stools and discomfort after defecation; huge broad ligament fibroids can compress the ureter and even cause hydronephrosis.
(3) Pain Under normal circumstances, uterine fibroids do not cause pain, but many patients may complain of lower abdomen swelling and back pain. Acute abdominal pain can occur when subserosal fibroids occur with pedicle torsion or red degeneration of uterine fibroids. Fibroids with endometriosis or adenomyosis are not uncommon and may have dysmenorrhea.
(4) Increased leucorrhea Increased uterine cavity and increased endometrial glands, combined with pelvic congestion, can increase leucorrhea. When ulcers, infections, or necrosis occur in submucosal fibroids of the uterus or cervix, bloody or purulent leucorrhea occurs.
(5) Infertility and miscarriage Some patients with uterine fibroids are infertile or prone to miscarriage. The impact on conception and pregnancy outcome may be related to the growth position, size and number of fibroids. Huge uterine fibroids can cause deformation of the uterine cavity and hinder the implantation of the gestational sac and the growth and development of the embryo; the fibroids compress the fallopian tube and cause the lumen to be blocked; the submucosal fibroids can hinder the implantation of the gestational sac or affect the sperm to enter the uterine cavity. The spontaneous abortion rate of patients with fibroids is higher than that of the normal population, and the ratio is about 4:1.
(6) Anemia: Hemorrhagic anemia can be caused by long-term menorrhagia or irregular vaginal bleeding. More severe anemia is more common in patients with submucosal fibroids.
(7) Others A very small number of patients with uterine fibroids can produce polycythemia and hypoglycemia, which are generally believed to be related to the production of ectopic hormones by the tumor.
2. Signs
(1) Examination of the abdomen The uterus is enlarged more than 3 months of pregnancy or larger subserosal fibroids at the bottom of the uterus, which can be palpated and masses above the pubic symphysis or in the middle of the lower abdomen, solid, without tenderness, if it is a multiple uterus Fibroids are irregular in appearance.
(2) Pelvic examination. Gynecological double diagnosis and triad examination showed that the uterus was enlarged to varying degrees, less regular, with irregular protrusions on the surface of the uterus, showing solidity, and soft texture if it had degeneration. The signs of uterine fibroids during gynecological examinations vary according to their different types. If the pedicled subserosal fibroids have a longer pedicle, they can be palpable and a substantial mass near the uterus, and they can move freely. This situation is easily confused with ovarian tumors. Submucosal fibroids descend to the orifice of the cervical canal and the uterine orifice is loose. The examiner can touch the smooth spherical tumor with his fingers inserted into the cervix. If it has protruded outside the cervix, the tumor can be seen. The surface is dark red and sometimes has ulcers. Necrosis. Larger cervical fibroids can shift and deform the cervix, and the cervix can be flattened or moved up to the back of the pubic symphysis.
an examination
1. Ultrasound
It is currently the most commonly used auxiliary diagnosis method. It can show that the uterus is enlarged, irregular in shape, the number, location, size of the fibroids, and whether the fibroids are uniform or liquefied or cystic. Ultrasound examination not only helps in the diagnosis of uterine fibroids, and provides a reference for distinguishing whether fibroids have degeneration, but also helps to differentiate from ovarian tumors or other pelvic masses.
2. Diagnostic curettage
Detect the size and direction of the uterine cavity through the uterine cavity probe, feel the shape of the uterine cavity, and understand whether there is a mass in the uterine cavity and its location. For patients with abnormal uterine bleeding, it is often necessary to identify endometrial lesions, and diagnostic curettage is of great value.
3. Hysteroscopy
Under the hysteroscope, it can directly observe the shape of the uterine cavity and whether there are neoplasms, which is helpful for the diagnosis of submucosal fibroids.
4. Laparoscopy
When fibroids need to be differentiated from ovarian tumors or other pelvic masses, laparoscopy can be used to directly observe the size, shape, and tumor growth site of the uterus and initially determine its nature.
5. Magnetic resonance examination
Under normal circumstances, there is no need to use magnetic resonance examination. If it is necessary to differentiate between uterine fibroids and uterine sarcomas, magnetic resonance, especially enhanced delayed imaging, can help distinguish uterine fibroids and uterine sarcomas. Before laparoscopic surgery, MRI can also help clinicians understand the location of fibroids before and during surgery and reduce residuals.
Differential diagnosis
Fibroids are often confused with the following diseases and should be differentiated: ① Uterine adenomyosis and adenomyoma; ② Pregnant uterus; ③ Ovarian tumor; ④ Uterine malignant tumor; ⑤ Uterine hypertrophy; ⑥ Uterine inversion; ⑦ Uterine malformation; ⑧ Pelvic inflammatory mass.
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