What are the methods to remove uterine fibroids?

Uterine fibroids are the most common tumors of the female reproductive organs. We know that surgery does not necessarily mean that fibroids grow, and surgery does not necessarily require removal of the uterus. So what are the methods to remove uterine fibroids? Surgical methods for uterine fibroids include dilation and curettage, myomectomy, transvaginal submucosal fibroid removal and hysterectomy. Which method to use should be considered comprehensively based on the patient's different age, condition, and fertility requirements, weighing the pros and cons.

1. Dilation and curettage is mainly used in the following situations: ① Menorrhagia, suspected to be caused by intimal hyperplasia and polyps; ② To determine whether there are submucosal fibroids; ③ To exclude malignant transformation of the endometrium. If the patient is near menopause, dilation and curettage can not only help diagnose, but also be a treatment method for menorrhagia, at least a measure to quickly stop bleeding.

2. Abdominal myomectomy: Because uterine fibroids are one of the possible causes of infertility, the only way for some young patients to have children is to perform myomectomy to remove the "culprit". According to experience, most fibroids can be removed one by one without hysterectomy. After removing fibroids and preserving the uterus, about half of the women are expected to have a successful pregnancy. This is an encouraging figure. Before uterine fibroid removal surgery, you need to do some examinations, because in some cases it is meaningless to do this surgery, such as if the man has infertility, or if he is over 40 years old, it will be difficult to get pregnant even if the fibroids are removed. : It is also necessary to know whether the fibroids have malignant transformation; besides, there are some problems in myomectomy itself, which should be fully understood before the operation. First, the recurrence rate of fibroids after removal is high. About 20% will have fibroids grow again, and half of them require another surgery to remove the uterus. Of course, if the uterus is removed in the first operation, it will be "once and for all." The reason for recurrence may be that fibroids are often multiple, and the tiny tumor foci that were not found during surgery gradually grow larger under the influence of hormones; it may also be that old fibroids are dug out and new ones grow back. Secondly, myomectomy leaves wounds on the uterus, often more than one. If you become pregnant in the future, you should be especially careful about uterine rupture, which is one of the key targets of obstetric monitoring. If the trauma of removal is relatively large, it is safer to give birth by cesarean section. Contraception should be used for one year after myomectomy surgery to prevent the wound from becoming strong and being stretched, causing serious consequences of uterine rupture. However, the period of contraception should not be too long. On the one hand, conception usually occurs within 3 years after surgery, and on the other hand, fibroids often recur more than 3 years after surgery. Therefore, it is best to use contraception for one year to try to get pregnant before recurrence. For fibroid patients who already have children, it is better to have a hysterectomy. Myomectomy is not a substitute for hysterectomy if there are no fertility problems.

3. Intravaginal pedunculated fibroid removal: suitable for submucosal uterine fibroids that protrude into the cervix or vagina.

4. Hysterectomy: suitable for multiparous women, those with large fibroids, obvious symptoms, unclear diagnosis, and possible malignant transformation. Subtotal hysterectomy and total hysterectomy are possible. At present, most people advocate total hysterectomy. There are two surgical approaches for total hysterectomy: abdominal and vaginal. If cervical fibroids and broad ligament fibroids deform the uterus and its ligaments, making the operation difficult, myomectomy can be performed first and then total hysterectomy if there is no requirement for childbearing. Whether to retain the ovaries or not depends on age and other circumstances.