子宫的良性和恶性病理学。

Benign and malignant pathology of the uterus.

机构信息

St. George's University of London Medical School, Nicosia University, Nicosia, Cyprus; European Academy for Gynecological Surgery (Nicosia Branch), 55 Andrea Avraamides Street, 2024, Strovolos, Nicosia Cyprus.

St. George's University of London Medical School, Nicosia University, 93 Agiou Nikolaou Street, Engomi 2408, Nicosia, Cyprus.

出版信息

Best Pract Res Clin Obstet Gynaecol. 2018 Jan;46:12-30. doi: 10.1016/j.bpobgyn.2017.10.004. Epub 2017 Oct 16.

DOI:10.1016/j.bpobgyn.2017.10.004

PMID:29126743

Abstract

The diagnosis of a uterine myoma size and location can be very precise when a 3D sonograph and knowledge are available. The majority of fibroids are asymptomatic, and expectant management is recommended. In young patients, fibroids cause infertility and in middle-aged women, abnormal uterine bleedings. Laparoscopic myomectomy is the preferred way of surgery for IM and SS fibroids, versus hysteroscopy for SM fibroids. In both cases, the size, number of fibroids and the surgeon's experience determine the limitations of the MIGS. Medical treatments provide only temporary tumor reduction and symptom alleviation. Leiomyosarcoma risk is higher in older women usually carrying fibroids larger than 8 cm. There are no other pathognomonic parameters ruling out a sarcoma. In case of suspected fibroid malignancy, the best treatment option is laparotomy and total hysterectomy. Myomectomy complications can be reduced when MIGS is performed by a surgeon with proper training and experience.

摘要

当有 3D 超声和相关知识时，子宫肌瘤的大小和位置的诊断可以非常精确。大多数子宫肌瘤没有症状，建议采用期待治疗。在年轻患者中，子宫肌瘤会导致不孕，而在中年妇女中，子宫肌瘤会导致异常子宫出血。对于肌壁间肌瘤和浆膜下肌瘤，腹腔镜子宫肌瘤切除术是首选的手术方法，而对于黏膜下肌瘤，则采用宫腔镜切除术。在这两种情况下，肌瘤的大小、数量和外科医生的经验决定了 MIGS 的局限性。药物治疗只能暂时缩小肿瘤并缓解症状。较大的子宫肌瘤（通常大于 8 厘米）在老年女性中，平滑肌肉瘤的风险更高。没有其他特定的参数可以排除肉瘤。如果怀疑肌瘤恶变，最佳治疗选择是剖腹手术和全子宫切除术。当具有适当培训和经验的外科医生进行 MIGS 时，可以降低肌瘤切除术的并发症。