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Wednesday 14 May 2014

Removal Of Fibroids Uterus

Uterine artery embolization (UAE) - The term "embolization" means blockage of the blood vessels supplying the organ, which leads to the cessation of the blood supply.

The uterus is provided by four arteries. Two of them - Uterine - nourish and fibroids. Loss of blood supply of the uterus through the uterine arteries becomes destructive of fibroids, knots "shrink" and the healthy tissue of the uterus continues to eat normally due to blood flow in the other two arteries - ovarian - and other small arteries.

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The main advantage of this method: after the UAE there is no need to take medications and procedures - you solve the problem of uterine fibroids once and for all.

Removal of fibroids uterus - This operation has been known for over a hundred years, but doctor’s resort to it infrequently and only reluctantly technically it is quite complicated and not all clinics have surgeons who own such equipment.

Myomectomy is most often carried out to young nulliparous women, to save the uterus. There are two variants of operation: Laparoscopic when it is performed through a small incision using special instruments under the control of the camcorder, and laparotomy or abdominal when operation is performed by the surgeon hands.

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Obvious advantages of the laparoscopic method - less blood loss and faster recovery after surgery. But it requires a very high skill of the surgeon.

The hardest part - "quality" to sew the uterus, the seams are not separated during pregnancy and childbirth.

Methods Of Treatment Of Uterine Fibroids

Observe or treat? If small (no more than 2-2.5 cm) nodes discovered by accident during the ultrasound and did not make themselves known, you can temporarily do without treatment and observe the behavior of nodes.

At the same time ultrasound should be performed at least once a year. If the nodes are growing, it is necessary to begin treatment immediately and not wait for their further increase, even if asymptomatic.

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However, there is another option: assign medication immediately. Modern hormonal contraceptives successfully inhibit the growth of small fibroids; the size of which does not exceed 2-2.5 cm alternative to oral contraceptives may be hormonal intrauterine system.

This is a common intrauterine device, but it contains a container with a hormone which in small doses is gradually released into the uterine cavity within 5-6 years.

Methods of treatment of uterine fibroids - Uterine fibroids can be reduced in size to stabilize and remove.

Reduce fibroids are two types of treatment: medication therapy and uterine artery embolization (UAE). But disappear altogether node cannot, everyone has a limit.

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The general rule is amenable to large nodes "reduction" worse. They tend to be a high proportion of connective tissue, is not amenable to regression (regress).

There is an analogy with an apple, which is converted to dried fruit: apple more than, the more will come of it dried fruit, juicier than it was, the more it will decrease during drying.

Symptoms And Diagnosis For Fibroids Removal

Presentation is about the purpose of women having changed, but every month a woman's body is set to pregnancy.

In the second phase of the cycle several uterus increases in size in preparation for the upcoming pregnancy. But pregnancy does not occur, and "disappointed" the body returns to its normal state.

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Multiple "failures" of this complex process leads to the accumulation of "errors". Disease, infection and medical interventions only aggravate the situation.

There is another opinion: the appearance of fibroids associated with trauma to the uterus repeatedly recurring menses.

According to the plan of nature in my life woman was supposed to have not more than fifty menstruation. The modern woman is experiencing them ten times more.

Symptoms and Diagnosis - Most often, the initial stage of the disease is asymptomatic. But at this stage it is best to treat. Therefore, annual visits to a specialist should be the norm. At later stages of the typical symptoms may appear:
•    Prolonged and heavy menstruation,
•    Acyclic (i.e., occurring in addition to menstruation) uterine bleeding,
•    Pain in the lower abdomen, "smack" in the waist.

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However, at certain localization even large nodes cannot be felt. Large (more than 3-4 cm) fibroids can be found in the usual probing of the uterus.

Small (less than 2 cm) can be seen during an ultrasound. With the help of ultrasound can measure the size of each fibroids node, count them and determine the location.

Doctors Usually Offered To Remove Uterine Fibroids

If the tumor is increased or been the cause of other complications, doctors usually offered to remove the uterus, meanwhile, in the nature of "extra" bodies do not exist, and the removal of the chief women's body entails a violation of not only physiological but also psychological balance. For a long time considered benign uterine fibroid tumors, which, like any such neoplasm may eventually develop into malignant.

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Therefore, it fought a radical way - operated, often completely removing the body. In 90 years as a result of the study, researchers found that the type of cells forming her uterine fibroids is not typical benign tumor and, accordingly, a malignant tumor is reborn as rare as unchanged uterine tissue.

This means that in most cases there is no need for emergency surgery. Then there were the methods for early diagnosis of the disease and prevention of uterine fibroids and non-operational methods of treatment and now scientists are unanimous that uterine fibroids can and should be treated.

And the earlier we start treatment, the better the result. Surgery to remove the uterus is only necessary in the most severe cases.

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It causes of hormonal background does not always have a value: uterine fibroids and formed in women with completely normal hormonal.

Nature has created a woman for procreation. Her life was to consist of a succession of pregnancies and childbirth feedings.

Mostly Fibroids Practically Does Not Show Any Symptoms

Symptomatology - Mostly fibroids practically does not show any symptoms and gynecologists often find the disease accidentally during a routine inspection. The most striking symptoms are manifested only when tumor when she was big.

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Diagnosis of uterine fibroids is not much difficulty. In a conventional examination, the gynecologist will be seen that the uterus is increased. Used to confirm the diagnosis:

•    Pelvic ultrasound with a full bladder, if you want to do an ultrasound in Krasnodar , contact the multidisciplinary medical center "clinician";

•    Hysteroscopy, mainly used for tumor;

•    Laparoscopy, used when it is impossible to distinguish from fibroid tumors in the ovaries;

•    MRI - is rarely used, since this kind of research is expensive to maintain.

Most often, for an accurate diagnosis is enough routine inspection in the gynecological chair and ultrasound.

Treatment - The main treatment is divided into two types: surgical or conservative. Conservative treatment with hormonal therapy, prescribed to women who have contraindications to surgery, if a woman is pregnant and she has less than 12 weeks.

Surgical treatment - is made when there is no opportunity to recover a conservative method.

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Indications for surgery: intensive tumor growth, miscarriage and infertility, uterine fibroid tumors in combination with a tumor of the ovary.

Fibroids risk factors - Several years ago, the diagnosis of "uterine fibroids" sounded like a death sentence. He condemned woman agonizing wait for surgery. Fortunately, today the situation has changed: fibroids can be treated.

The Most Suitable Option For Fibroid Treatment

It is important that the surgeon owned all these methods and techniques could be combined to select the most suitable option each specific patient, and not to adjust the situation under their capabilities.

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Laparoscopy - such access to the abdominal cavity, where through punctures (5-10 mm) are introduced tools and a laparoscope (a thin optical system through which the surgeon gets the picture of it is displayed on a monitor in the operating room).

Laparoscopy allows not violating the anatomical tissue ratio, to operate in accordance with the natural landmarks, delicately with respect to the fine structure, located in the zone of operations, minimize the frequency of the formation of adhesions.

Moreover, the laparoscopic surgeon working in this perspective, which allows you to see areas inaccessible by other means, why is this happening?

First, the camera image is displayed on the monitor with magnification. Secondly, uses miniature instruments.

Thirdly, during an operation in the abdominal cavity is pumped gas, which helps to operate, stratifying physiological tissue and space?

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When the undoubted benefits of the laparoscopic approach to the laparotomy (namely minimal trauma of the anterior abdominal wall, less likely to develop adhesions, shorter hospital stay and postoperative rehabilitation, the best effect) in the laparoscopic removal of "difficult" sites surgeon is faced with certain difficulties.

By "hard" nodes are nodes larger (more than 7.8 cm), positioned on the rear wall and the rib in the uterus intraligamentary nodes.

Treatment For Uterine Fibroids

"Gold standard" treatment for uterine fibroids in Western Europe and the United States recognized myomectomy (surgical removal of fibroids of the uterus).
When this operation is performed "husking" fibroids and their subsequent removal and careful suturing of the uterine body.

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A characteristic feature of the presence of momma node capsule is around the site. Therefore, the removal ("husking") node can be done within the capsule without damaging the surrounding tissue of the myometrium.

According to the recommendations of foreign societies of obstetricians, preservation of the uterus as the body during surgical treatment of uterine fibroids, it is important not only for the patients planning pregnancy, but also for women who want to retain menstrual function until the onset of natural menopause and, in general, as a body of the uterus.

Therefore, when performing surgery for fibroids leading surgeons tend in most cases to use ablative techniques.

Ablative surgery for uterine fibroids performed trans abdominal and trans-vaginal access. By Trans abdominal approach includes laparotomy, laparoscopy and Mini laparotomy.

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Trans-vaginal cervical nodes removed fibroids, myomectomy and operate hysteroscopy nodes, choosing random access dependent upon a number of factors (size of the uterus, its mobility, the number of nodes, the presence of accompanying somatic pathology, etc.).

It should be understood that it is not about the different types of transactions, and the different ways through which the surgeon gains access to the operative body.

Surgical Treatment Depends On Several Factors

This time-regression method is shown at the small size of uterine fibroids in some patient’s perimenopausal age, for the prevention of growth of nodes, as well as for the prevention of recurrence after myomectomy widely used monophasic oral contraceptives.

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Surgical treatment of uterine fibroids - Indications for surgical treatment of uterine fibroids are:

•    Menstrual dysfunction (uterine bleeding).

•    Large sizes node.

•    Submucous and centripetal growth nodes.

•    Pain syndrome.

•    Infertility and miscarriage.

•    Subserous location of the site (on the leg).

•    Atypical location of the cervical node.

•    Dysuric phenomenon.

Choosing the size, access and timing of surgical treatment depends on several factors. If desired, save the patient's reproductive function, menstrual function, or simply as a body of the uterus is definitely preferred myomectomy.

Today is clearly defined contraindications to myomectomy. Performing conserving surgery on the uterus is not shown in the identification process of cancer of the female reproductive sphere, as well as the presence of inflammatory processes of the abdominal cavity.

Despite the fact that contraindications to the preservation of the uterus are very limited, in most cases, patients with uterine myoma proposed operation.

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In Russia, uterine fibroids hysterectomy operation is performed in different regions from 60 to 96% of cases.

In Moscow (2009 data) frequency operations was 68%, in this regard, the relevant broader introduction into clinical practice of organ treatments for uterine fibroids.

Treatment Of Uterine Fibroids

Intraoperative sonography (ultrasound during surgery performed by a sensor) reduces the risk of not leave the remote nodes. Since the late 80s began extensive research into circulation of the uterus and ovaries using transvaginal ultrasound combined with Doppler velocimetry and the DRC (color Doppler).

Currently, it is generally accepted that this method provides a detailed assessment of the structure of non-invasive body and its vascular bed.

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Qualitative and quantitative analysis of indicators intragenic flow allows us to characterize the physiological changes that occur in the uterus and ovaries during the menstrual cycle and in various pathological conditions of the genitals, as well as the formation of new vessels to register in the event of cancer.

Treatment of Uterine Fibroids - Not all fibroids need to be treated, in certain cases it is possible follow-up. But in order to decide in each case, should consult a specialist.

The principal objectives of treatment are removal of the tumor or (surgery) or inhibition of tumor growth and regression of tumors (conservative treatment).

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Opportunities hormone (gonadotropin-releasing hormone) is limited and involve a number of side effects. Reduction in the amount of nodes in patients receiving these drugs occurs only in some patients and that at the time of admission

After discontinuation of treatment sizes nodes return and even become larger. Drugs that stop the growth of or permanently cure fibroids, today does not exist!

Often Patients Complain Of Infertility And Miscarriage

With poor circulation in the site of pain is acute and very intense. Often patients complain of infertility and miscarriage.

Known close relationship of uterine fibroids and infertility: among patients with primary infertility fibroids detected in each of the third, and every fifth patient with uterine cancer suffer from infertility.

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Tumor nodules can lead to infertility and pregnancy loss by changing the size of the uterus, mechanically squeezing the tube angle and worsening local blood flow in the uterine endometrium over the node.

Thus, the clinical picture of uterine fibroids has a great diversity of symptoms, but most often manifests triad uterine bleeding, pain and dysfunction related bodies, diagnosis of uterine fibroids usually uncomplicated and available at the stage of gynecological examination, anamnesis and of bimanual examination.

The main non-invasive instrumental methods of diagnosis of this pathology are ultrasound, CT and MRI. A routine method of uterine fibroids is an ultrasound scan using trans abdominal and trans-vaginal probes for more accurate visualization of nodes and their features.

Trans-vaginal ultrasound sensitivity in the diagnosis of uterine fibroids was 96.1% and specificity - 83.3%.

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In formativeness it second only to laparoscopy with subseries localization of nodes having absolute superiority in interstitial their location.

Echo graphic study to determine the size, number, location and location of the tumor, the presence dis-circulatory disorders, and the minimum diameter of fibroids, revealed during trans-vaginal ultrasound scan, reached 8 mm.