子宫肌瘤3公分以上且血供丰富应尽早手术 Uterus iliacus the neoplasm be 3 cms of above and the blood supply be abundant should as early as possible surgical operation

原本计划怀个“金猪宝宝”，结果提前孕检发现，竟然患有子宫肌瘤。因此，不得不先开刀，再准备怀孕……俗话说：“十女九瘤”。子宫肌瘤困扰着越来越多的女性。到底是保守治疗，还是该开刀切除？在上周的“名医网上聊”中，复旦大学附属妇产科医院妇科专家朱芝玲副教授与读者网聊了子宫肌瘤的治疗、预防等各种问题。

　　子宫肌瘤影响怀孕计划

　　不少计划怀孕的女性，在妇科检查中发现自己竟然患有子宫肌瘤。此时，原本的怀孕计划可能要泡汤了。到底是否一定需要手术剥离肌瘤呢？朱芝玲副教授对此表示，是否手术一定要先想清楚。因为一般在手术剥离子宫肌瘤后的一年内，不能马上怀孕；如果子宫肌瘤长在宫腔内，则至少需要一年半至两年时间之后才能计划怀孕。

　　但专家也表示，一般来说，如果子宫肌瘤的生长位置是在子宫肌壁间和子宫浆膜面上，而且大小在3公分以下的，则也不需要手术剥离。不过，带瘤生存毕竟也还是有一定的风险，需要密切随访；但如果子宫肌瘤大小在3公分以上，而且血供丰富，则应尽早手术。建议是否手术、推迟计划怀孕，还是以医生的分析、判断作为参考最合适。

　　手术与否需综合考虑

　　“子宫肌瘤是否需要马上手术，是需多方面综合衡量、判断的！”朱芝玲副教授分析，这关键还是要看子宫肌瘤的位置、大小、生长速度、患者年龄以及生育要求等多方面的要求，以此来综合决定。比如：对于子宫黏膜下的子宫肌瘤和宫颈肌瘤，不管子宫肌瘤的大小，都是需要尽早手术的；但如果子宫肌瘤的大小是在5公分以下的、且无明显症状的、也不会引起任何不适的、生长速度又很缓慢，主要表现为子宫肌瘤的血供不丰富、无变异的，则可以不用马上手术。建议平时坚持每三个月至半年一次的随访，来密切关注。

　　专家表示，对于在2公分至5公分范围之内的子宫肌瘤，一般可保持每三个月至半年之间随访一次；而对于1公分以下的子宫肌瘤，无明显症状，则可保持每年随访一次。

　　手术治疗尚存两大误区

　　不少爱美的女性不愿意切除卵巢、子宫，生怕因此影响到美丽的容颜，今后很快衰老……“在手术治疗中，是否保留子宫和保留卵巢的问题上，目前还存在两个误区！”朱芝玲副教授感叹，“一部分女性始终认为：自己被切除了子宫，就等于变成了‘男人’！”

　　专家说，这两种观点其实都不可取。和生命相比，尽早接受科学的治疗，才是治愈疾病的关键。尤其是50岁以上的女性，本来卵巢就已经没有功能了，若卵巢有疾病则可以切除，以降低风险。而对于70岁的老太太而言，是否切除卵巢、子宫，其实基本一样的，并没有任何意义。在临床上，还有一些女性因为盲目不愿切除，最后发生了恶变，危及生命。

　　腹腔镜手术有一定要求

　　还有不少年轻的子宫肌瘤女性患者问道：“听说腹腔镜手术不仅伤口的切口小，而且恢复快，是不是都适合做？”

　　朱芝玲副教授表示，腹腔镜手术还是有一定的要求的。如果是多发性的子宫肌瘤，一般在3个以内、最大的在8公分以下，则可接受腹腔镜手术；但具体情况还要根据手术医生的技术，如果医生技术水平高，可能10公分左右的子宫肌瘤也可以采用腹腔镜切除。

Uterus iliacus the neoplasm be 3 cms of above and the blood supply be abundant should as early as possible surgical operation


Original plan bosom"gold pig baby", effect advance Yun check detection, unexpectedly get uterus iliacus neoplasm.Therefore have to have operation first, then prepare be pregnant ……the common saying say:"Ten females nine neoplasms".The uterus iliacus neoplasm perplexs more and more females.BE an exactly conservative treatment, or should have operation excision?Replied the Dan university subsidiary gynecology expert's associate professor Zhu Zhi Ling2 and reader's net of the gynecology hospital to chat uterus iliacus the treatment, prevention...etc. of the neoplasm in the top"famous doctor net up chat" of the turnover is various problems.

Uterus iliacus neoplasm affect pregnancy plan

The female whom not a few plans be pregnant, detection oneself unexpectedly gets uterus iliacus neoplasm in the gynecology the check.At this time, the original pregnant plan may steep soup.Exactly whether does the certain need surgical operation remove iliacus neoplasm?Associate professor Zhu Zhi Ling2 said to this, whether the surgical operation must want first to know.Because general after the surgical operation remove uterus iliacus neoplasm of can't be pregnant right away in a year;If the uterus iliacus neoplasm grows in the temple antrum, then needing one and half years to two years at least then can plan a pregnancy after.

But expert also mean, generally speaking, if uterus iliacus the growth position of the neoplasm is on the uterus iliacus wall and uterus plasma membrane leontiasis ossea, is and size at less than 3, then also don't need a surgical operation dissection.However, take neoplasm to exist to after all also still keep there is certain risk, need closely with visit;But if the uterus iliacus neoplasm size at 3 cms of above, and the blood supply be abundant, then should as early as possible surgical operation.Suggest whether surgical operation, postpone a plan pregnancy, still use the doctor's analysis, judgement as a reference quite the cheese.

Surgical operation or not need comprehensive consideration

"Whether uterus iliacus neoplasm needs right away surgical operation or not, is need in many ways comprehensive measure, judgement!"Associate professor Zhu Zhi Ling2 analyze, this key still keeps needing to see uterus iliacus the position, size, the growth speed, sufferer's age of the neoplasm and grow to request an etc. various request, with this to comprehensive decide.For example:For under the uterus mucous membrane of the uterus iliacus neoplasm and the temple jugular iliacus neoplasm, ignore uterus iliacus the size of the neoplasm, is all need as early as possible surgical operation of;But if uterus iliacus the size of the neoplasm is at less than 5, and have no obvious symptom and can't cause, either any unwell, growth the speed be again very slow-moving, cardinal performance is the uterus iliacus blood supply of the neoplasm not abundant, have no dissociation of, then can need not right away surgical operation.Suggest to insist being a time for three months to half year each time at ordinary times with visit, come to close concern.

The expert said that for in 2-5 cms of the scopes inside of uterus iliacus neoplasm, generally can keep each time for three months to the of half year with visit once;But for less than 1 uterus iliacus neoplasm, have no obvious symptom, then can keep annually with visit once.

The surgical operation treats to still save two greatest mistakes area

Not a few females of love of beauties would not like to cut off ovary, uterus, fear to therefore affect beautiful facial appearance, from now on very quick decrepitude ……"in the surgical operation under medical treatment, whether reserve the problem of uterus and reserve ovary up, still exist two mistake areas so far!"Associate professor Zhu Zhi Ling2 feel deeply about, " a part of females always think:Oneself is cut off uterus, equaled to become'man'!"

The expert says that these two kinds of standpoints in fact and can't take.The demulcent therapy, reconciliation life compare, as early as possible accept the treatment of science, be cure of a paroxysm key.Particularly female over 50 years of age, the original ovary has already had no action, if the ovary have disease and can then cut off, since low risk.But for 70-year-old old woman but speech, whether cut off ovary, uterus, in fact basic and similar of, there is no meaning.At clinical up, have some female because the blindness doesn't wish excision, finally bad mutation happenned and endanger life.

The perioneoscope surgical operation has a certain request

Still haven't a few young uterus iliacus neoplasm a female sufferer to ask a way:"Hear perioneoscope surgical operation not only the incision sterigma of wound, and instauration quick, whether all in keeping with do?"

Associate professor Zhu Zhi Ling2 said that the perioneoscope surgical operation still has a certain request.If is deliver sexual uterus iliacus more neoplasm, general at 3 in, biggestly at 8 cms of following, then can accept perioneoscope surgical operation;But the concrete circumstance still wants according to the surgical operation doctor's technique, if doctor technique level Gao, the probably 10 cms of or so uterus iliacus neoplasm can also adopt perioneoscope excision.