Myoma node. Subserous node in the uterus Myoma on the anterior wall of the uterus

Every woman dreams of bearing and giving birth to a healthy child. Becoming a mother is a real happiness and a great responsibility. After all, a woman not only gives life to a new person, she is fully responsible for his life and development. And this responsibility arises even at the stage of pregnancy planning. That is why it is so important to pass before pregnancy full examination for the presence various pathologies female organs.

The uterus is the main reproductive organ of a woman, responsible for the implantation of the embryo and bearing the fetus.

One of the problems that women of childbearing age often face is subserous uterine fibroids. This is a benign tumor in the form of a node under the outer shell of the uterus, in the abdominal region (subperitoneal node) or in the pelvic region. Often consists of several nodes with different localization.

The node has a round shape, consists of smooth muscle fibers and has high density. It does not change the structure of the walls of the uterus and does not prevent pregnancy. It is attached to the uterus with its base or leg.

Symptoms, formation factors and complications of the subserous node

The nature of the symptoms directly depends on the size of the tumor and the stage of the disease. Many features are shared by different infectious diseases as well as intestinal disorders and Bladder which often confuses patients. Consider the following stages presented in the table.

This pathology develops against the background of such factors and diseases:

With improper treatment or untimely diagnosis, the disease is dangerous with the onset of complications in the form of slagging of the body ( wrong job intestines), pyelonephritis, kidney and bladder stones, uterine bleeding and infertility.

The large size of the tumor entails its rupture or twisting of the fibroid stem. Such phenomena cause peritonitis and tumor necrosis, which requires immediate medical intervention by the surgeon.

During pregnancy, there is a threat of miscarriage and premature birth, fetal hypoxia (oxygen starvation), caused by the flow of a significant amount of blood not to the child, but to the tumor itself. The most unfavorable complication is the degeneration of the tumor from benign to malignant - sarcoma.

Diagnostic detection methods

This formation has no age barrier and can appear both in 30-40 years and up to 20 years. Since this ailment is often asymptomatic, it can only be detected during a gynecological examination by palpation.

There are special technical procedures used by a doctor to detect fibroids:

Conservative therapy of subserous fibroids

At initial stages when there is no place for deformation changes in the uterus, the tumor lends itself well drug treatment, which is aimed at increasing immunity, restoring hormonal balance, eliminating the inflammatory process of the uterus. All this allows you to save the body and prevent the growth of fibroids.

Conditions for medical treatment:

• the initial stage of the disease;
• small size of the subserous node (less than 6 cm);
• slow growth rate of the neoplasm;
• surgery is contraindicated.

The main drugs used for such treatment are hormonal medicines and dietary and supportive care.

Group	Name of drugs	Mechanism of action	Contraindications	A course of treatment
Gestagens (steroid sex hormones)	Norkolut, Duphaston, Utrozhestan, Progestogel, Norprogesterone	Prevention of oncology, preventing the growth of the endometrium	Vaginal and uterine bleeding, pregnancy, thrombophlebitis, breast cancer	8 months
Combined oral contraceptives	Yarina, Janine, Regulon, Marvelon, Novinet, Lindinet, Ovidon	Stabilization of the size of myomatous nodes, normalization of menstruation, reduction of blood loss	deep vein thrombosis, arterial hypertension, stroke, ischemic disease hearts	3 months
Gonadotropic releasing hormone agonists	Buserelin, Zoladex, Triptorelin, Goserelin	Reducing the size of the subserous node, relief of pelvic pain	Pregnancy and lactation	2 to 6 months
Antigonadotropins	Gestrinone, Danazol	Suppression of ovarian steroid hormone synthesis	Heart disease, kidney disease, pregnancy, diabetes	8 months
Hormonal coils	Mirena, Levonova	Blocking neoplasm growth	cervicitis, postpartum endometritis, septic abortion, urinary tract infections	5 years

Along with these drugs, painkillers and anti-inflammatory drugs are used: Paracetamol, Ibuprofen, Ketoprofen, Naproxen and others.

Should I operate on subserous uterine fibroids?

If the medicines did not give the desired result, and the next ultrasound shows the growth of the tumor, its twisting or degeneration into a malignant one, an operation is immediately prescribed, which can be of 2 types:

1. With preservation of the uterus myomectomy and hysteroresectoscopy.
2. Without organ preservation- hysterectomy.

Myomectomy is aimed at removing fibroids using laparoscopy, hysteroscopy, laparotomy (incision of the abdominal wall) and enables a woman to become pregnant in the future. Used in patients reproductive age.

Hysteroresectoscopy is the removal of fibroids from inner surface uterus without abdominal incisions.

Hysterectomy is the complete removal of the uterus when the tumor is malignant. Lets save sexual life, but forever excludes the possibility of motherhood. There are laparoscopic, laparotomy and vaginal.

Subtypes of hysterectomy:

• total - removal of the uterus with the cervix;
• subtotal - preservation of the cervix;
• radical - amputation of not only the uterus and its cervix, but also parts of the vagina, as well as appendages.

The expediency of the operation is determined by the obstetrician-gynecologist or oncologist, taking into account the age of the patient, the nature of the neoplasm, the presence of blood loss.

This disease is not a sentence for a woman, if you follow certain rules and doctor's advice:

Early diagnosis and timely therapy will help a woman maintain reproductive function up to 40 years.

- a tumor-like nodular formation of a benign nature, developing from the myometrium against the background of its increased sensitivity to an imbalance of sex steroids. Manifestations of interstitial uterine fibroids can serve as heaviness and pain in the lower abdomen, meno- and metrorrhagia, anemia, dysuria, constipation, infertility, complications of pregnancy and childbirth. Interstitial uterine fibroids are diagnosed using ultrasound, CT (MRI) of the pelvic organs, dopplerography, hysteroscopy, laparoscopy. For the treatment of interstitial uterine fibroids, hormone therapy, FUS ablation, UAE, laser vaporization, myomectomy and hysterectomy.

General information

Small interstitial fibroids do not interfere with reproductive function, large nodes that strongly deform the uterus can cause uterine infertility or spontaneous abortion on different terms. The location of the fibroids in the area of ​​the mouth fallopian tube with compression of the latter complicates the process of conception. The growth of interstitial fibroids in the uterine cavity can disrupt the normal development of the fetus, lead to spontaneous miscarriage and premature birth. Attachment of the placenta in the area of ​​the node increases the risk of premature detachment and profuse bleeding. Interstitial fibroids uterus can cause complications in childbirth - weak labor and bleeding.

Diagnostics

The diagnosis of interstitial uterine fibroids is established using ultrasound, CT (MRI) of the pelvic organs, hysteroscopy, if necessary - WFD, diagnostic laparoscopy. With interstitial fibroids during a gynecological examination, it is possible to determine the increase in size and deformation (tuberosity of the surface, increased density) of the uterus.

Ultrasound of the small pelvis allows you to visualize even minor interstitial myoma nodes up to 0.8-1 cm, evaluate histological structure fibroids, direction of growth (centrifugal, centripetal). Homogeneity, hyperechogenicity of myomatous nodes indicates the predominance of fibrous tissue, the presence of intranodular hypoechoic inclusions indicates cystic cavities or necrosis, hyperechoic elements with an acoustic absorption effect indicate the calcification process. With the help of Doppler sonography, peri- and intranodular blood flow in the vasculature of the myomatous node is examined and the tumor morphotype is determined. With simple myoma, a single peripheral blood flow is fixed, with proliferating - enhanced central and peripheral. Low speed blood flow indicates necrosis or hyalinosis of the node.

Hysteroscopy helps to identify interstitial fibroids with centripetal growth due to deformation of the inner surface of the uterus, the presence of secondary changes in the myomatous nodes. Also, the determination of oncomarkers in the blood, WFD with a morphological analysis of endometrial tissue is carried out. Interstitial uterine fibroids must be differentiated from other types of fibroids, tumors of the uterus, pelvis and abdominal cavity (primarily malignant), pathological processes of the endometrium.

Treatment of interstitial uterine fibroids

A radical method of treating interstitial fibroids - removal of the uterus (hysterectomy, supravaginal amputation of the uterus without appendages) - is indicated for multiple, large sizes (13-14 weeks) and rapid growth myomatous nodes, especially in postmenopause, necrosis or cervical location of fibroids, severe bleeding, comorbidity. In young patients of reproductive age, minimally invasive, organ-preserving methods of treatment are preferred.

Functional surgery of the uterus with the removal of myomatous nodes (myomectomy) makes it possible to preserve menstrual and reproductive functions, prevent prolapse and disruption of the pelvic organs. Laparotomic access is indicated for multiple volumetric (> 7-10 cm) interstitial fibroids, cervical and isthmus nodes, especially posterior and lateral localization. small interstitial nodes removed only in preparation for pregnancy, before ovarian stimulation in case of infertility in women. Laparoscopic access is less common and often not recommended due to the risk of uterine rupture during pregnancy and childbirth. Pregnancy can be planned after 6 months. after myomectomy, delivery is preferred by caesarean section.

For small interstitial uterine fibroids without noticeable symptoms, it is possible dynamic surveillance with annual ultrasound control, with the exception of thermal and sunbathing, massage, physiotherapy. As conservative therapy COCs, gestagens, and sometimes androgens are used. It is possible to use the intrauterine hormonal system "Mirena". In order to create a drug-induced menopause, antigestagens (mifepristone), analogues of GnRH are used; GnRH agonists are effective in perimenopause. Innovative drugs for the treatment of fibroids are antifibrotic and antiangiogenic agents, analogues of somatostatin. alternative surgical treatment Interstitial uterine fibroids are UAE (uterine artery embolization), non-invasive FUS-MRI ablation, laser vaporization (laparoscopic myolysis).

Forecast

Interstitial uterine myoma is considered a favorable prognostically favorable formation: the tumor is benign, the risk of malignancy is minimal. However, in some cases, against the background of fibroids, primary and secondary infertility may develop, with radical surgical treatment, loss of menstrual and reproductive function in young patients.

Content

According to clinical research, the diagnosis of uterine fibroids is observed in 85% of women. This fact allows us to attribute this pathology to the most common diseases of the female genital area.

Uterine fibroids is a hormone-dependent tumor that grows in the muscle layer of the anterior or posterior wall of the uterus. The disease is typical for women 30-45 years old.

Myoma is located in different parts of the uterine wall. It can have both nodular and diffuse form. Most tumor-like formations are located in the uterine body in the form of nodes, for example, along the anterior wall. Only 5% of myomatous nodes are localized in the cervical part.

Many women, having heard about subserous nodes, are interested in what it is.

uterine fibroids located outside under it serosa, is subserous.

Subserous nodes of the uterus are formed on the surface of the organ and progress towards the pelvic cavity.

Subserous nodes can grow:

• on the leg;
• on a broad basis.

Subserous nodes are often multiple. According to their size, neoplasms can be:

• small;
• average;
• large.

Usually, the subserous node grows within five years to the sizes determined by instrumental methods. However, under the influence of negative factors, a rapid growth in education can be noted.

The volume of uterine fibroids, in particular, of the subserous type, is determined by gynecologists in weeks of pregnancy.

Reasons for the appearance

It is believed that the growth of subserous uterine fibroids is due to hormonal imbalances. Among the factors provoking the disease are also distinguished:

• surgical interventions in the woman's history;
• genetic predisposition;
• inflammatory diseases of the genital organs;
• long-term use of COCs;
• pathology thyroid gland and adrenal glands;
• stress;
• absence of pregnancies, childbirth and lactation up to 30 years.

Specialists distinguish several stages of the formation of subserous uterine fibroids.

1. There is an active growth of the tumor from the smooth muscle elements of small blood vessels, characterized by increased permeability of the vascular wall.
2. The stage of rapid progression of fibroids, which can only be determined microscopically.
3. A subserous myomatous node can be diagnosed during the examination by a gynecologist.

As a result of hormonal fluctuations there is an excessive proliferation of smooth muscle cells or their excessive reproduction.

During histological examination, deformed cells are found, while connective tissue remains unchanged.

Kinds

Pathology has several clinical forms. Specialists classify subserous nodes as:

• leiomyoma, consisting of smooth muscle cells;
• fibromyoma, including a significant amount of connective tissue;
• bizarre leiomyoma, in which giant cells with large nuclei are determined;
• epithelioid cell leiomyoma with indistinct boundaries;
• leiomyolipomas, characterized by the content of fat cells.

Subserous nodes may differ in different localization.

• intramurally located. Intramural subserous tumors develop externally and are relatively harmless. Neoplasms localized intramurally do not lead to deformation of the uterus. It is believed that intramural subserous nodes also do not cause infertility.
• Interstitial-subserous. Interstitial nodules form inside the anterior or posterior wall of the uterus. The formations differ in development in the pelvic area and are mixed. As a rule, such a pathology leads to an increase in uterine body. In this case, a large knot along the front or back wall uterus can negatively affect neighboring organs.

Interstitial-subserous nodes, for example, the anterior wall of the uterus, often cause surgical interventions. While intramurally located fibroids have a more favorable prognosis.

Clinical picture and complications in the development of subserous nodes in the uterus

Subserous nodes, which are often located intramurally along the anterior wall, mostly progressing without symptoms.

However, when the uterine neoplasm reaches a significant volume, a compression effect occurs, directed at the tissues surrounding the tumor. As a result, there are various violations internal organs located in the pelvis.

Gynecologists name several symptoms characteristic of subserous nodes, including those that form intramurally along the anterior wall of the uterus.

• Changes affecting the nature of menstruation. A woman may notice an increase in spotting, as well as lengthening the duration of critical days.
• Acyclic bleeding. With uterine benign pathology, the contractile function organ, which causes the appearance of intense bleeding. Over time, the constant loss of blood often causes anemia.
• Constant urge to urinate. Disorders associated with the function of the excretory system occur due to compression of the bladder, as it is located anterior to the uterus and a large uterine formation.
• Pain of varying intensity. Pain depends on the location of the formation. When the tumor is located intramurally along the anterior wall, pain occurs only with large nodes. In this case, the pain may be localized above the pubis or lower back. Many women note that the onset of pain often occurs after intense physical activity or during critical days.
• Infertility and miscarriage. This sign characteristic of the serous-interstitial variety of pathology.

Long-term developing subserous nodes of the uterus can lead to various complications:

• torsion of the leg of the node;
• tumor necrosis;
• purulent-inflammatory processes.

With torsion of the leg and subsequent necrosis, symptoms appear " acute abdomen", which are accompanied severe pain, loss of consciousness, pressure drop, vomiting. !!! This complication requires immediate surgical intervention.

Methods of diagnosis and treatment

It is worth noting that such a formation as the uterus needs mandatory monitoring and treatment. Majority benign neoplasms proceed latently, which indicates the need for timely diagnosis.

It is possible to assume the disease during a gynecological examination. By palpation, an experienced doctor reveals a spherical enlarged uterus and probes large formations. To confirm the diagnosis, it is necessary to instrumental methods research:

• gynecological ultrasound;
• laparoscopy.
• diagnostic hysteroscopy.

The main way to diagnose the disease is a gynecological ultrasound. When prescribing therapy, a hormonal study may be required.

Treatment of the disease is determined by the growth rate, size and type of tumor. Significant value in choosing medical tactics has the age of the patient, as well as her reproductive plans.

With small volumes of fibroids, some doctors use expectant tactics. However, this approach can lead to further progression of the disease.

The gold standard in the treatment of uterine fibroids is a combination of medical and surgical tactics. Drug therapy is appropriate for fibroids with a volume of up to 12 weeks in the absence of severe symptoms. Within the conservative or drug therapy The following hormonal preparations are recommended for the patient:

• antigonadotropins;
• agonists of gonadotropic releasing hormones.

Conservative tactics also involve the use of anti-inflammatory, hemostatic agents. The purpose of the drug technique is to stabilize the growth of uterine fibroids and reduce its clinical manifestations.

The main way to treat uterine fibroids, in particular, localized intramurally along the anterior wall, is to remove it by various surgical techniques.

Indications for surgical treatment are:

• rapid progression of fibroids;
• oncological alertness;
• neoplasms exceeding 12 weeks in volume;
• frequent bleeding;
• intense pain.

Surgical intervention is carried out by methods:

• organ-preserving treatment through laparotomy and laparoscopic myomectomy, UAE and FUS ablation;
• radical surgery with a hysterectomy or extirpation of the uterine body.

Despite the benign nature of subserous uterine fibroids, she demands competent diagnostics and subsequent appropriate treatment.

Most women are afraid of the "terrible" diagnosis - subserous uterine fibroids. The operation to remove the uterus seems inevitable to them, which means that infertility is inevitable. Is this really true and is it worth panicking? In order to understand this issue, it is necessary to have an idea of ​​what a fibroid is, why it occurs and what methods of treatment currently exist.

Please note that this text was prepared without the support of our.

General information about uterine fibroids

The development of uterine fibroids is due to impaired regulation of the growth of myometrial cells. The formation of myomatous nodes is most often associated with hormonal abnormalities in the woman's body and damage to the uterine tissue.

Hormonal disorders that provoke the development of a tumor may relate to both reproductive system, so the endocrine sphere. So, reduced thyroid function (hypothyroidism) and obesity lead to an increase in estrogen levels, which, in turn, is a predisposing factor in the occurrence of fibroids.

The regulation of cell growth can be impaired due to damage to smooth muscle cells, which often happens during curettage of the uterine cavity, abortion, inflammatory processes in the uterus and prolonged use of intrauterine contraceptives. In addition, the development of a tumor may be due to hereditary predisposition, unfavorable environmental situation, frequent stress and decreased immunity, which increases the body's susceptibility to damaging agents.

Myoma nodes can be single and multiple, their size can be several millimeters and tens of centimeters. Myomatous formations are localized mainly in the body of the uterus, in some cases the disease affects the neck of the organ and its ligamentous apparatus.

Disease prevalence

Uterine fibroids are the most common benign tumor in the female genital area. Most often, the disease is diagnosed in women aged 30 to 48 years.

There are also cases when myomatous nodes were found in younger women, under the age of 20 years.

Localization of uterine fibroids

Fibroids can affect various parts of the uterus. The following localizations are considered the most common:

• subserous - begins development from the outer part of the uterus and continues its growth outward into the pelvic cavity. This type pathology, as a rule, does not lead to a violation of the menstrual cycle, however, it can cause some discomfort associated with its size and compression of the surrounding tissues by a knot.
• intramural - grows in the middle muscle layer of the uterus and leads to a significant increase in its size, the appearance of pain and a feeling of pressure in the pelvis, and also violates menstrual cycle. This type of tumor is the most common;
• submucosal (submucosal) uterine fibroids - occurs deep in the uterus, under a thin layer of endometrium lining its cavity. This type of disease is manifested by severe symptoms and is less common than others.

Symptoms of uterine fibroids

More than a third of cases of uterine fibroids occur without characteristic symptoms and the disease is detected only during a scheduled visit to the gynecologist. This is especially true of intramural and subserous nodes of small sizes.

The intensity of manifestations of fibroids depends on factors such as the size and number of nodes, their localization and morphological features.

Women may complain of the following symptoms:

• profuse, prolonged menstruation with pronounced pain syndrome;
• intermenstrual spotting and bleeding;
• clots in menstrual flow;
• pain in the abdomen, lower back and above the pubis;
• feeling of pressure and heaviness in the lower abdomen.

The most pronounced manifestations are observed in women with multiple or large uterine fibroids.

In addition, with myoma, the functions of nearby organs are disrupted, there is a problem with carrying a pregnancy, and infertility develops.

The pain syndrome that accompanies pathology has a different origin.

Interstitial uterine fibroids of small size are manifested by long, heavy and painful menstruation.

With the active growth of nodes, a woman experiences constant pain of a aching nature. Necrosis of the node is accompanied by severe pain, fever, symptoms of intoxication of the body. A similar emergency situation occurs with subserous uterine myoma with nodes on the leg. If the leg is thin, the knot may be twisted, as a result of which its power is disrupted. In such situations, an acute condition occurs - a pronounced pain syndrome. In some cases, a woman may develop peritonitis, requiring urgent surgical treatment.

With myoma big size the function of nearby organs is disrupted, which leads to constipation and increased urination. Sometimes the myomatous node compresses the ureter, as a result of which the outflow of urine from the kidney is disturbed.

Submucosal myoma with submucosal localization of the node is manifested by heavy menstruation. With large sizes of the submucosal node, which occupies a large area of ​​the uterine cavity, there is a violation of cyclicity menstrual flow and sometimes complete cessation.

The clinical manifestation of subserous (subperitoneal) fibroids is pain. Pain is felt in the lower abdomen or lower back. They are due to tension. ligamentous apparatus uterus and pressure of the growing myomatous node on nerve plexuses small pelvis. With impaired blood circulation in the tumor, the pain increases and becomes acute.

Uterine fibroids can cause infertility and miscarriage, which is explained by a change in the size of the uterine cavity by the growing nodule, mechanical compression of the tubal angle and deterioration of local blood flow in the endometrium.

Thus, uterine fibroids can have a varied clinical picture, but most often manifested by a triad: bleeding, pain and dysfunction of adjacent organs.

What is subserous uterine fibroids

Subserous uterine fibroids are benign tumor, affecting the outer side of the uterus, its growth is directed to the pelvic cavity.

Subserous myoma looks, as a rule, in the form of a node with a wide base or a thin leg, through which the tumor is fed. Nodes can be single or multiple. A single node with subserous uterine myoma is covered by a capsule that separates it from the surrounding tissues. The myomatous node can be small and large, but usually no more than 10 cm.

Due to its localization on the outside of the uterus and growth in abdominal cavity subserous uterine fibroids is considered one of the most harmless tumors. In women with fibroids of this type, the size of the uterus does not increase and menstrual function is not disturbed. There are no problems with the onset of pregnancy. Difficulties with conception can occur only in cases where the subserous node is located near one of the fallopian tubes and compresses it. However, the presence of this tumor can cause miscarriage.

Types of subserous uterine fibroids

In modern gynecology, there is the following classification of subserous fibroids:

• zero type - subserous node on the leg, not containing an intramural component;
• the first type - the value of the intramural component is less than 50% of the volume of the myoma formation, most of it is subserous;
• the second type is a myomatous node with an intramural component of more than 50%, with a mild subserous component.

Reasons for the development of subserous uterine fibroids

The development of this benign formation may be due to the following predisposing factors:

• endocrine disorders: according to statistics, subserous fibroids most often develop in women before the onset of menopause or during it, when the usual ratio is disturbed female hormones- progesterone and estrogens;
• hereditary predisposition: if the woman's close relatives suffered from this disease;
• traumatization of the muscular layer of the uterine wall during childbirth, during pregnancy or heavy uterine bleeding.

Symptoms of subserous uterine fibroids

Patients with subserous nodes usually complain of having pain. Most often, the pains are pulling, aching in nature, localized above the pubis and can radiate to the lumbar region.

The pain syndrome intensifies in case of hypothermia, overwork, a long stay in an uncomfortable position and after intense physical activity.

Diagnosis of subserous fibroids

After collecting an anamnesis: clarifying the patient's complaints, genetic predisposition, anamnesis of life and illness, the gynecologist prescribes a series of laboratory and instrumental studies:

• blood test (at least three times): general - to exclude inflammatory processes, biochemical and hormonal;
• gynecological examination;
• ultrasound: is considered the main diagnostic method;
• computed and magnetic resonance imaging: to determine the size, location of the tumor in the uterine cavity and in relation to adjacent organs.

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Treatment of subserous uterine fibroids

The tactics of treatment of subserous fibroids is selected in accordance with the size of the tumor. For example, the most effective method treatment of large fibroids is considered surgery to remove the nodes. With small myoma nodes, it may be sufficient to use conservative therapy, uterine artery embolization, or regular monitoring of neoplasm growth using ultrasound (at least four times a year). Thus, surgery is not the only method of treating this pathology.

conservative therapy.

Conservative treatment of subserous uterine fibroids involves taking drugs such as:

• combined oral contraceptives (progesterone-containing and estrogen-containing);
• gestagens;
• antiestrogen (not used to treat fibroids in patients under 45 years of age);
• antigonadotropins and gonadoliberins.

The duration of conservative therapy is three months. During this period, a woman must follow a special diet. After finishing taking the drugs, a woman needs to remain under regular supervision of a specialist to monitor the condition of the myomatous node.

Unfortunately, hormonal therapy rarely leads to a stable result, relapses often occur: growth and enlargement of nodes. In this situation, surgical intervention is necessary.

Subserous uterine fibroids: dimensions for surgery

Surgery for subserous uterine myoma can be a treatment option for large nodes and in cases where the node grows on a thin stalk. The operation can also be performed with infertility and the presence of severe pain, uterine bleeding that cannot be treated with conservative methods.

Hollow operation. One type of surgical treatment is abdominal operation aimed at removing the myomatous node. Indications for its implementation are the large size of the node, as well as the malignancy of the process - the degeneration of a benign form into a malignant one. The incision is made in the area above the pubis. Then all layers (skin, subcutaneous fatty tissue, peritoneum, etc.) are dissected in layers, after which the fibroids are excised.

Hysterectomy. With a very large fibroid that compresses adjacent organs and it is impossible, for one reason or another, to remove the myomatous node, a woman is prescribed a hysterectomy. During such operations, the uterus is removed along with the node. Hysterectomy is a radical treatment for fibroids. This operation is used only in cases where the disease threatens the woman's life.

Laparoscopy. Currently, the removal of uterine fibroids is most often performed by the laparoscopic method. Through a slit in the front abdominal wall a laparoscope is inserted, after which the myoma is excised and removed. This is a minimally invasive method, after which there are no cosmetic defects - postoperative scars.

Uterine artery embolization (UAE). An innovative method of uterine artery embolization is an effective and safe organ-preserving alternative to surgery. The basis of this technology is the cessation of nutrition of the myomatous node by introducing special balls - embolus, blocking the blood flow in the uterine arteries. With the help of UAE, a stable life-long effect is achieved, relapses of the disease are excluded. This is the most preferred treatment for fibroids, avoiding surgery.

FUS-ablation. A method that involves exposure to uterine fibroids with ultrasonic waves. The effectiveness of the procedure is high only in the treatment of fibroids with small single nodes.

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Diet for subserous uterine myoma

In the process of treatment, a woman must follow the following dietary rules:

• give preference vegetable food with a high content of fiber, with the help of which the metabolism is normalized;
• reduce the amount of meat consumed;
• refuse fatty, fried and spicy foods;
• eat vegetables and fruits daily;
• introduce soy products, bran into the diet, which cleanse the body of toxins;
• to normalize the level of hormones, regularly eat nuts, dairy products;
• eat dishes from fatty varieties of sea fish that have antitumor effects.

Improper nutrition can cause serious disruptions in the endocrine system and active growth myoma formations.

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Traditional medicine

ethnoscience has large quantity recipes for herbal infusions and decoctions, with which you can significantly reduce the severity of symptoms of subserous fibroids, as well as stop the growth of myomatous nodes. However, these funds should only be accepted as additional method at complex therapy and only after consultation with the attending physician.

Flax seeds. Due to the content of antiestrogens, flax seeds have positive effect in the treatment of this hormone-dependent tumor. Preparations from flax seeds help to restore hormonal balance, contribute to the suppression of inflammatory processes and counteract carcinogens that provoke the development of tumors.

Potato juice. This remedy has a wound healing, anti-inflammatory, antispasmodic, analgesic, diuretic, tonic, immunostimulating effect, and also normalizes metabolism and the body's water-salt balance. In addition, similar healing properties also has a decoction of potato flowers. However, the intake of potato juice is contraindicated in patients suffering from diabetes, intestinal dysfunction, gastritis with low acidity.

Boron mother. This plant is rightly called "women's grass". With the help of infusion of the upland uterus, many gynecological problems are solved, including uterine fibroids.

Poisonous plants. Due to their antitumor properties, tinctures of hemlock, aconite, hellebore and celandine are successfully used in the treatment of subserous uterine fibroids. It is important to understand that these plants should be purchased only in pharmacy packages, which contain instructions for use, because. preparations from poisonous herbs must be taken strictly in the indicated doses.

Hemostatic herbs. When uterine fibroids are complicated by profuse uterine bleeding, infusions and decoctions from plants that have a hemostatic effect can be taken. The following contribute to a decrease in the volume of secreted blood: barberry, nettle, shepherd's purse, yarrow, burnet, burdock, cloves.

Leeches. The saliva of leeches contains enzymes and other biologically active substances that help restore the level of hormones in the female body, due to which the treatment with leeches has a positive effect in such a hormone-dependent tumor as uterine fibroids. In addition, hirudotherapy helps to thin the blood, eliminate congestion in the blood vessels of the small pelvis, strengthen immunity, and reduce inflammation.

No need to be afraid to be treated, you need to be afraid of getting sick! In order to prevent fibroids, a woman needs to adhere to a healthy lifestyle, avoid heavy physical exertion, abortion, take care of her body, and if any alarming symptoms are found, do not hesitate to contact the doctor. Any disease is treated easier and more effectively in the early stages, and uterine fibroids are no exception.

We will help you choose the best specialists who use in their practice organ-preserving methods of treatment of fibroids, incl. and embolization of the uterine arteries, as the most preferred way to get rid of fibroids without surgery. Our partners are leading clinics in Moscow and other Russian cities. Contact us to any doctor of the clinic with which we cooperate. . We will provide ongoing support. For all your questions.

Bibliography

• Sidorova I.S. Uterine fibroids (modern aspects of etiology, pathogenesis, classification and prevention). In: Uterine fibroids. Ed. I.S. Sidorova. M: MIA 2003; 5-66.
• Androutopoulos G., Decavalas G. Latest Achievements in the treatment of uterine fibroids. Translation from English. N. D. Firsova (2018).
• Savitsky G. A., Ivanova R. D., Svechnikova F. A. The role of local hyperhormonemia in the pathogenesis of the growth rate of the mass of tumor nodes in uterine myoma // Obstetrics and gynecology. - 1983. - T. 4. - S. 13-16.

There are several types of myomatous nodes. A subserous myomatous node is located on the outside of the uterus and may have a base - a leg. Its structure determines the methods of therapy for this condition.

Uterine fibroids occur due to dysregulation of cell growth muscle tissue organ. The impetus is most often hormonal disorders and previous surgeries on the uterus.

Myoma can be single and differ in localization. According to medical classification distinguish the following types of tumors:

1. Submucosal myomatous neoplasm- located in the submucosa of the organ on a thin stalk.
2. Interstitial, or intramural- located between muscle layers uterus.
3. subserous tumor- localization outside the uterus, may have a leg.
4. Intraligamentary node- located on the ligaments or between them.
5. Less common born and nodules in the cervix.

The development of the pathological process in the uterus is influenced not only by the hormones of the sexual sphere, but also by dysfunction of the thyroid gland. For example, hypothyroidism is combined with an increase in estrogen levels. This can serve as an impetus for the development of a benign hormone-dependent tumor.

After cavity curettage, setting the spiral, the uterine mucosa is often damaged and its structure is disturbed. Unfavorable factors are also a combination of effects on the body bad heredity, unfavorable environment, negative emotions and weak resistance to pathogenic microorganisms.

They range from 1.5 cm to a dozen cm. However, more often they are found when they reach at least 4-5 weeks.

Diagnosis of subserous fibroids

Despite the fact that subserous uterine myoma is a benign formation, it is capable. The rate of malignancy depends on the type of fibroids and the totality of the influence of external factors.

When diagnosed, a fibroid of this type looks like a knot on a wide base or stalk, through which its nutrition and growth is carried out. A single node is covered by a capsule, limited from surrounding tissues, and easily visualized. Multiple formations are difficult to isolate from each other. The diameter of each of them does not exceed 10 cm.

Localization outside the uterus limits the involvement of the tumor in and does not contribute to organ enlargement. As a result, there are no obstacles to conceiving a child. If the subserous node is located near the fallopian tube, it can lead to a violation of its patency as a result of compression. In this case, maintaining the pregnancy is difficult.

Types of subserous uterine fibroids

In gynecology, a convenient classification of subserous nodes is provided.

According to her, all fibroids of this type are divided into the following types:

• zero subserous node on the leg, differs in that it is not intramural.
• In the first type, the percentage of the content of the intramural component occupies half of the node.
• They speak of the second type when the intramural content is more than half of the node and the subserous component is less pronounced compared to the first type.

The myomatous node along the anterior wall is found in most women, the location along the posterior wall is typical for. The subserous node grows into the peritoneal cavity and unfolds in rare cases.

Reasons for development

As noted, the following factors can influence the development of a tumor:

• disruption of the endocrine system;
• hereditary predisposition;
• damage to the myometrium of the uterus.

Pathologies of a subserous nature are focused on pain sensations of a pulling, aching nature. The area of ​​their localization - top part abdomen, irradiation to the back is observed.

The pain may intensify after physical overwork, numbness of the pelvic muscles, against the background of colds.

How is subserous fibroids diagnosed?

A standard appointment with a gynecologist includes a mandatory history taking, a study of the history of chronic pathologies. Advanced medical examination includes a blood test (clinical detailed, biochemistry, hormones); inspection with mirrors; ultrasound examination; magnetic resonance imaging.

Treatment Methods

Treatment can be radical. Upon detection of a neoplasm early stage development tactics of observation is allowed. In this case, we are talking about fibroids up to 12 weeks of pregnancy. If a hormonal background women do not require correction,
sanitize only chronic foci of infection.

Medical therapy

At a size of 12-15 weeks, treatment with oral and hormonal contraceptives will be effective to reduce the production of hormones by the ovaries. Medicines are taken for at least six months. Another therapy option is. This method of treatment combines the contraceptive function. The peculiarity of the last method of therapy is that the spiral is placed only in women who have given birth. To use hormonal drugs there are contraindications:

• increased amount of glucose in the blood;
• phlebeurysm;
• hypertension.

Additionally, symptomatic drugs are prescribed: painkillers, iron, vitamin complexes, hemostatic drugs. Physiotherapy includes magnetotherapy, radon baths.

Treatment during pregnancy

A subserous myomatous node can be detected during pregnancy on ultrasound. What are the complications of this pathology? If the neoplasm is located on the leg, its torsion may occur. The operation is carried out, taking into account all the risks to the fetus. When the pregnancy cannot be terminated, expectant management remains. The growth of fibroids can lead to squeezing of the ureters, which will lead to disruption of the kidneys, development dangerous state- pyelonephritis. Due to irradiation in the area of ​​​​the rectum, its inflammation occurs. However, observation of the entire period of pregnancy allows timely prevention of complications for mother and baby. When determining the tactics of therapy, the doctor takes into account several factors:

• gestational age;
• size and type of tumor;
• location of education;
• the patient's age.

Large tumor is removed surgically, by laparoscopy or abdominal method. The choice of tactics is determined by the doctor according to the indications.

Surgery

Absolute indications for removal of the uterus are its development on the leg and large size. Also, the surgical method is resorted to with a pronounced nature of pain, infertility and the ineffectiveness of conservative therapy with medications.

Abdominal surgery is used as a radical method of getting rid of the tumor. Indications for its implementation:

• large node size;
• tumor degeneration.

Myoma is excised in the suprapubic region after dissection of all layers of tissue.

A hysterectomy involves removing the tumor along with the organ. It is carried out according to vital indications and only to women who have given birth.

Laparoscopy is a modern sparing method. Its advantage is the absence of postoperative scars, rapid rehabilitation after surgery.

Uterine artery embolization is rarely used. The method consists in stopping the supply of the node after blocking the blood flow to it. This method is an alternative to surgery.

Planning for pregnancy after surgery

Doctors always try to save the uterus during surgery to remove fibroids. The duration of recovery depends on the type of therapy chosen, individual physiological features women. In any case, if the recommendations of the attending physician are followed, conception can be planned as early as a year after the operation, with normal tissue healing.

Nutrition with a subserous node

A well-formulated diet also has great importance to restore the body of a woman. To normalize work digestive tract, the level of hormones and vitamins, you must adhere to the following scheme:

1. To normalize metabolism, food should be plant-based, contain enough fiber.
2. Buy lean meats: poultry, veal.
3. Avoid spicy, spicy, fried foods.
4. Eat dairy products, grain products daily to remove toxins from the body.
5. Marine fish has an antitumor effect and contains a complex of minerals.

Improper nutrition during the rehabilitation period will slow down the recovery process and cause general harm body.

After thirty, a woman should undergo a complete gynecological examination every six months, this significantly reduces the risk of developing pathologies of the reproductive system. Regular care of your health minimizes negative factors.

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