Obstetrics and gynecology. Uterine fibroids (most important)

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Obstetrics and gynecology. Uterine fibroids (most important)

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53. Uterine fibroids

Classification. Based on location, they distinguish between uterine fibroids (occurs in 95% of cases) and cervical fibroids (cervical fibroids - in 5% of cases). In relation to the myometrium, there are three variants of growth of fibroid nodes: intermuscular, or interstitial (the tumor is located in the thickness of the uterine wall), submucosal, or submucosal (fibroids grow towards the uterine cavity), subperitoneal, or subserous (fibroids grow towards abdominal cavity).

In the event that the submucosal tumor is located mainly in the muscle layer, the term "intermuscular uterine myoma with centripetal growth" is used. A special form of submucosal nodes of fibroids - giving birth to tumors, when their growth in the uterine cavity occurs towards the internal pharynx. Long-term growing emerging myomatous nodes lead to smoothing and opening of the uterine os, as a result of which the tumor extends beyond the external opening of the uterus.

The clinical picture of uterine myoma depends on the age of the patient, the duration of the disease, localization, size of the tumor and the presence of concomitant extragenital pathology. Often, small uterine fibroids are asymptomatic, while there are no complaints and menstrual dysfunction.

The main symptoms of the disease are pain of varying intensity, bleeding (meno- and metrorrhagia), dysfunction of neighboring organs. The most common pain is in the lower abdomen and lower back. Severe prolonged pain most often indicates the rapid growth of the tumor. Acute pain occurs mainly when blood supply to the tumor is disturbed, which can lead to the development of necrosis with a clinical picture of an acute abdomen.

Cramping pains during menstruation, as a rule, indicate a submucosal location of the node. Bleeding with uterine myoma are in the nature of hyperpolymenorrhea. With multiple uterine fibroids with interstitial nodes, the uterine cavity is stretched and its surface is enlarged. This increases the amount of blood lost during menstruation. Rapid growth of fibroids refers to an increase in the size of the uterus, approaching the size of a 5-week pregnancy in a year or less. A rapid increase in neoplasm in some cases may indicate the malignancy of the process.

Violation of the function of neighboring organs is observed with large tumor sizes, as well as with subperitoneal, cervical and interligamentous arrangement of nodes.

The most common complication of uterine fibroids is necrosis of the myomatous node, torsion of the node located on the leg. Necrosis of the myomatous node is accompanied by acute pain, fever, the development of a picture of an acute abdomen. Subserous nodes are most often exposed to necrosis. Torsion of the legs of the myomatous node is a common complication of fibroids. In this case, the nutrition of the tumor is disturbed, dystrophic and degenerative changes, edema occur. It gives the impression of rapid tumor growth.

Author: Ivanov A.I.

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