Promising ways to treat unpromising uterine fibroids
Background. Preventive check-ups reveal uterine fibroids for the first time in 1-5 % of women. In the presence of gynecological diseases this number is about 30-35 %. Pathomorphological examination of deceased women of different ages reveals fibroids in 77-85 % of them. The age of this diagnosis has become significantly younger, and it is important, because uterine fibroids are associated with problems with fertilization and pregnancy. Myomas are divided into types by localization (interstitial, intraligamentary, subserous, interstitial-subserous, submucosal, etc.).
Objective. To describe current trends in the treatment of uterine fibroids.
Materials and methods. Analysis of own experience in the treatment of fibroids and literature sources on this topic.
Results and discussion. Conservative myomectomy can be performed laparotomically, laparoscopically and hysteroscopically. It is often impossible to perform a traditional conservative myomectomy of large nodes of II-V grades without significant damage to the uterine wall, so as a result, conservative myomectomy turns into a hysterectomy. HiFu ablation is an another method of treating fibroids. This method is based on the influence of a high-power ultrasonic wave, which is generated by a radiating lens and passes through the patient’s body to the pathological focus. Degasated water acts as a conductor between the patient’s body and the lens. The goals of treatment are to preserve the uterus and to create the possibility of pregnancy. Before treatment, magnetic resonance imaging of the pelvic organs and assessment of the potential for malignancy must be performed. Criteria for the selection for ablation include the desire to preserve the uterus; established diagnosis of uterine fibroids, local adenomyosis; obvious symptoms of fibroids (abnormal uterine bleeding, dysmenorrhea, pain, secondary anemia); node size 1-15 cm (submucosal or intramural type of growth). The preservation of a woman’s fertility is a main indication for ablation. There are no alternative methods to HiFu ablation in terms of efficacy and safety, but if the nodes were too large or too numerous, conservative myomectomy is performed after significant tumor regression after two sessions of HiFu. The nodal bed and pelvic floor should be washed with decamethoxine solution during the operation. The required volume of solution is about 2 liters. The advantages of decamethoxine include the lack of absorption by the wound surface and a powerful bactericidal effect. If the walls of the uterus are thin and it is not possible to preserve their integrity during myomectomy, plastic surgery is performed with the introduction of high molecular weight hyaluronic acid to prevent the formation of adhesions and accelerate regenerative processes.
Conclusions. 1. Uterine fibroids are common tumors that in young women are accompanied by problems of fertilization and pregnancy. 2. It is often impossible to perform traditional conservative myomectomy of large nodes without significant damage to the uterine wall. 3. HiFu ablation is the modern method of treatment of fibroids. 4. Maintaining a woman’s fertility is a main indication for ablation.
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