How to treat cervical myoma [Talking about the selection and analysis of surgical methods for cervical myoma]

China Library Classification. R4 ID number B1008-1879 (2012) 07-0072-02 Cervical myoma is a special type of uterine myoma. Because the composition of cervical smooth muscle is far less than that of uterine body, cervical myoma is rare, and literature reports account for 2%-5% of uterine myoma and 5.2% of cases. Cervical fibroids are divided into four types: anterior wall, posterior wall, lateral wall and hanging wall (submucosa). Different types of fibroids have different treatment methods. The surgical method should be based on the patient's age, fertility requirements, the size and location of fibroids, and whether it is necessary to preserve the uterus. The data of 46 cases of cervical myoma were analyzed and discussed.

Clinical data of 1

From June 2006 to October 2006 10, 46 patients with cervical myoma underwent abdominal surgery, all of which were single. It accounts for 65438 0.5% of the patients with hysteromyoma undergoing abdominal surgery in the same period. Submucosal fibroids or uterine fibroids removed from the vagina are not included.

Among the 46 cases with the age distribution of 1. 1, the youngest is 24 years old (unmarried) and the oldest is 58 years old. There were 35 cases aged 3 1 ~ 50 years, accounting for 76.08%, which was similar to the onset age of hysteromyoma. Except 1, all the other cases were married and had children.

1.2 classification According to cervical anatomy, the cervix can be divided into cervical vaginal segment and upper cervical segment. Myoma was located in vaginal segment in 26 cases and cervical segment in 20 cases. According to the cervical orientation, it can be divided into anterior wall myoma 16 cases, posterior wall myoma 26 cases and lateral wall myoma 4 cases.

The main clinical manifestations of 1.3 are menstruation and mass. Among the 46 cases, menorrhagia 15 cases, found by general survey or perceived by patients themselves 17 cases. In addition, there are a few cases with dysuria and increased leucorrhea as the main symptoms.

1.4 intraoperative findings and surgical methods.

1.4. 1 Uterine morphology In all cases, the uterine body was normal or slightly larger during the operation, while the cervix was enlarged, which made the uterus deformed in different degrees, such as "dumbbell" and "hat"; Some cervical tubes are flat and the cervix is "crescent-shaped". 1.4.2 The size of myoma is 24×20×20cm 3 1 case,1.8×16×16cm35 cases,12×1case.

1.4.3 Among other cases, there were 2 cases of monthly pregnancy, 2 cases of ovarian tumor 1 case and 2 cases of uterine malformation.

1.4.4 operation mode. Total hysterectomy was performed in 40 cases, subtotal hysterectomy in 3 cases, total hysterectomy in 3 cases, and hysterectomy for cervical myoma: generally, after the uterine blood vessels were blocked (i.e., the anterior and posterior leaves of ligament were cut separately, the uterine artery was cut off and sutured), the myoma was removed first, and then the uterus was removed according to the routine operation, so as to reduce the damage and bleeding to adjacent organs during the operation. The average blood loss in this group is about 370ml, which is related to the size of myoma.

Two methods

2. 1 Cervical leiomyoma is similar to leiomyoma of uterine body in general and histological morphology, and can originate from cervical connective tissue and smooth muscle cells. However, some scholars believe that the cervix contains very little smooth muscle, far less than the uterine body, especially the cervix and vagina, and there is almost no smooth muscle tissue. It is speculated that fibroids may come from vascular smooth muscle cells.

2.2 Misdiagnosis of cervical leiomyoma, especially when it grows in the upper cervical segment, will lead to difficulties in diagnosis, mainly because cervical leiomyoma is less common than uterine leiomyoma, and there is no significant difference in clinical manifestations between them. The cervical canal is flattened, the cervix is crescent-shaped, the cervical canal is enlarged and the uterus is deformed during the operation, which suggests that we should pay attention to these special signs during gynecological examination, which is very helpful for diagnosis. In addition, hysterography can show the elongation and bending deformation of cervical canal.

2.3 surgical methods. Most of the cases in this group have developed into a large area of cervical myoma, which is difficult to operate, easy to damage adjacent organs and causes more blood loss during operation. Therefore, the author thinks that the diagnosis of cervical myoma is clear, and the operation should be done as soon as possible to reduce the complications. Of course, we can also observe tiny fibroids regularly. Once there is an aggravating trend, it is necessary to operate as soon as possible. Surgical methods: Large cervical myoma, especially when it grows in the posterior or lateral wall of the cervix, is often embedded in the pelvic cavity, and it is difficult to expose the ureter during the operation. After blocking the uterine artery, the myoma is removed to restore the original anatomical position and shape of the cervix, so as to continue the hysterectomy. All patients were treated with the above method, and there was no complication of damaging adjacent organs. Many hospitals believe that this method is safe. The key is to cut the capsule of myoma clearly, slide and peel it close to the tumor surface in the connective tissue between myoma and capsule, and completely remove the myoma, so as to reduce bleeding and avoid damaging the ureter. For unmarried or childless young patients, simple myomectomy can be considered, and the tumor cavity should be closed during the operation to prevent bleeding and infection. In this group, 3 cases underwent myomectomy, of which 1 case was unmarried large cervical myoma. They underwent myomectomy and cervicoplasty. After the operation, their menstruation was normal and they got married a year later. Now they have been pregnant for six months, and the situation is good. After further follow-up, the other 2 cases had normal menstruation and no abnormality in gynecological examination for more than 2 years after operation. It is reported that the effect of hysteromyomectomy is ideal, and the indications of hysteromyomectomy should be relaxed for young patients, and it should be performed before marriage to prevent pregnancy complicated with tumor, fibroid degeneration or obstruction of birth canal.

2.4 Relationship with pregnancy It is generally believed that infertility caused by cervical myoma blocking the cervical canal is rare. Except 1 unmarried cases, all of them have given birth, but pregnancy is closely related to delivery. There were 4 cases of pregnancy in this group, of which 2 cases of full-term pregnancy were operated because of obstruction of birth canal. Usually, the myoma of the anterior wall of the cervix can rise to pubic symphysis with the enlargement of the uterus, and most of them do not affect the birth canal, while the myoma of the posterior wall is confined by peritoneum. When the uterus is enlarged, it cannot rise, and it is embedded in the pelvic cavity, which often blocks the birth canal. Literature reports that fibroids are more common in the posterior wall, and this set of data is also that the posterior wall is more than the anterior wall. Therefore, routine gynecological examination should be carried out in early pregnancy, and more attention should be paid to the location when cervical myoma is found, so as to estimate the impact on delivery. As for the treatment of intraoperative myoma, there is no unified opinion at present. Most scholars believe that uterine congestion during pregnancy, a single myomectomy can lead to massive bleeding, and hysterectomy is recommended. However, some scholars believe that pregnancy complicated with myoma is easy to gouge out and suture, and the key lies in clear hierarchy. It is necessary to cut the whole capsule and expose the gray myoma for peeling and enucleation to avoid massive bleeding. If the myometrium is separated from the capsule by mistake, it will cause massive bleeding due to the tearing of the myometrium during pregnancy.

3 discussion

Cervical leiomyoma is a special type of uterine leiomyoma, and its incidence accounts for 2.2%-8% of uterine leiomyoma. The growth site of cervical myoma is low, or it grows into subperitoneum or broad ligament, close to pelvic organs such as peripheral blood vessels and ureters, with abundant blood supply, which makes peripheral organs shift, disrupts normal anatomy, and increases the difficulty of operation and the incidence of complications. According to its growth position, cervical myoma is officially divided into four types: anterior wall type, posterior wall type, lateral wall type and overhanging type (submucosal cervical myoma), which can also grow in many directions.

The exact cause of hysteromyoma is unknown, which may be related to high estrogen level and long-term estrogen stimulation. (1) occasionally seen in women after menarche, more common in middle-aged women. After menopause, fibroids stop growing and gradually shrink; ② Myomas are often associated with endometrial hyperplasia; ③ Patients with ovarian granulosa cell tumor and theca cell tumor (which can secrete estrogen) often have hysteromyoma; ④ Estrogen level increased during pregnancy, and myoma increased rapidly; ⑤ Exogenous estrogen can accelerate the growth of myoma.

Cervical myoma is a common and frequently-occurring disease in women. More and more women suffer from cervical myoma, which makes the incidence of cervical myoma always high. Cervical fibroids can cause frequent urination or dysuria, and some can also cause constipation. If the patient has menorrhagia for a long time and is not treated in time, it will lead to severe anemia, even shortness of breath and palpitation, which will affect heart function and pregnancy.