子宮肌瘤的處理建議

 資料來源：https://jamanetwork.com/journals/jama/fullarticle/2824424

**子宮肌瘤概述：**

- **發病率**：子宮肌瘤是生育年齡女性常見的良性腫瘤，影響 約40% 至 89% 的米國更年期前女性。米國黑人女性的肌瘤數量較多、尺寸較大，症狀也比白人女性更嚴重。子宮肌瘤是美國進行子宮切除術的主要原因。

**症狀和體徵**：

- 症狀包括經血過多或經期延長、下腹部增大、頻尿、便秘、腹痛、腰背痛、骨盆或直腸疼痛、性行為疼痛、不孕，以及缺鐵和貧血。有些人可能無症狀。

**診斷**：

- 根據症狀可懷疑子宮肌瘤，通過骨盆檢查和骨盆超聲確診。磁共振成像（MRI）可提供更精確的影像，有時可能需要進行活檢。

**治療考量**：

- 治療取決於肌瘤的特徵、症狀、患者偏好、是否有生育需求，以及是否希望保留子宮。無症狀的患者可能僅需定期監控，手不必太癢，就想動手割除。

**藥物治療**：

- **非荷爾蒙治療**：使用非成癮非類固醇的抗炎止痛藥（如布洛芬或萘普生）來緩解疼痛和經血過多，氨甲環酸治療經血過多，造血鐵劑補充，可以治療貧血。

- **荷爾蒙治療**：包括口服避孕藥、口服黃體素、釋放荷爾蒙的子宮內裝置，以及促性腺激素釋放激素類似物，可以影響子宮內膜的生長調控，來減少出血。

**手術和程序治療選項**：

- **肌瘤切除術**：挖除子宮內的肌瘤，保留子宮以便未來懷孕。

- **子宮切除術**：去除整個子宮，是治療子宮肌瘤的最終手段，但無法再懷孕。

- **其他程序**：

   - 子宮動脈栓塞術，通過減少肌瘤的血供來縮小肌瘤的尺寸大小。

   - 子宮內膜的消融術，用於減少月經的出血。

   - 子宮內膜切除術，減輕出血症狀。

   - 高強度超聲波治療，用熱治療肌瘤，適合仍希望生育的患者。

**Uterine Fibroids Overview:**

- **Prevalence**: Uterine fibroids are benign tumors common among reproductive-aged women, affecting 40%-89% of premenopausal women. Black women tend to have more fibroids, larger sizes, and more severe symptoms than White women. Fibroids are the leading cause of hysterectomy in the U.S.

  

**Signs and Symptoms**:

- Symptoms include heavy/prolonged menstrual bleeding, abdominal enlargement, frequent urination, constipation, pain, infertility, and anemia. Some individuals may remain asymptomatic.

**Diagnosis**:

- Fibroids are suspected based on symptoms and can be confirmed through pelvic examination and pelvic ultrasound. MRI may be used for detailed imaging, and in some cases, a biopsy may be needed.

**Treatment Considerations**:

- Treatment is personalized, considering fibroid characteristics, symptoms, patient preferences, fertility desires, and whether the patient wishes to preserve the uterus. Asymptomatic patients may only require monitoring.

**Medical Treatments**:

- **Nonhormonal**: NSAIDs for pain and heavy bleeding, tranexamic acid for heavy bleeding, and iron supplements for anemia.

- **Hormonal**: Treatments include oral contraceptives, progestins, hormone-releasing devices, and gonadotropin-releasing hormone analogues to reduce bleeding.

**Surgical and Procedural Options**:

- **Myomectomy**: Removes fibroids, preserving the uterus for future pregnancy.

- **Hysterectomy**: Removes the uterus, definitively treating fibroids but eliminating future pregnancy.

- **Other Procedures**: 

   - Uterine artery embolization to shrink fibroids.

   - Endometrial ablation for reducing bleeding.

   - Hysteroscopic endometrial resection for symptom relief.

   - High-intensity ultrasound for nonsurgical treatment in patients wishing to maintain fertility.