Uterine hypertrophy

Introduction to uterine hypertrophy Hypertrophyofuterus refers to the uniform increase of the uterus. The basic pathological change of this disease is the change of smooth muscle cells and blood vessel wall in the myometrium. The uterus is evenly enlarged, and the muscular layer is 2.5 to 3.2 cm thick. The cut surface is grayish white or pink, the hardness is increased, and the fiber bundles are arranged in a braided shape. The arteries and veins are obviously dilated, and there is a cluster of elastic fiber proliferation around the new blood vessels. A disease with varying degrees of uterine bleeding. The main clinical symptoms are increased vaginal discharge. In addition, due to connective tissue hyperplasia and inflammation spread along the cervix or through the uterine ligament to the pelvic cavity, there is pain in the lumbosacral or perineal bulge. The main symptoms are excessive menstrual flow and prolonged days; there are also cases in which the cycle is shortened to about 20 days, and there is no significant change in the amount and duration of the day; or the menstrual period is prolonged, but the amount is not much. basic knowledge The proportion of sickness: 0.5% - 0.8% Susceptible people: women Mode of infection: non-infectious Complications: cervical erosion

Cause of uterine hypertrophy

Chronic uterine insufficiency in multi-partum women (20%):

Proliferative fibrotic tissue in the myometrium of the progenitor hyperplasia between smooth muscle and perivascular, long-term stimulation of chronic inflammation, cervical congestion, edema, cervical gland and interstitial hyperplasia leading to different degrees of hypertrophy of the cervix.

Ovarian dysfunction (20%):

Estrogen continues to stimulate, can make the myometrium hypertrophy, clinically common patients with functional uterine bleeding, especially those with longer course of disease, have varying degrees of uterine enlargement. Cervical hypertrophy generally does not require treatment, if there is erosion, it can treat cervical erosion.

Inflammation (10%):

Chronic attachment inflammation, pelvic connective tissue inflammation and chronic myositis of the uterus cause collagen fibers in the myometrium to proliferate and cause uterine fibrosis.

Pelvic blood stasis (5%):

Causes uterine connective tissue hyperplasia, can also cause uterine hypertrophy.

Myometrial vascular sclerosis (5%):

Primary uterine vascular disease and so on.

Uterine hypertrophy prevention

Because the cause of the disease is multi-faceted, some can prevent it from happening, such as family planning, prevention of postpartum infection, postpartum uterine contraction, and timely delivery of uterine contraction drugs, pay attention to postpartum appropriate prone or knee chest position and postpartum exercise, Anti-uterine fall, reduce pelvic congestion, actively treat ovarian dysfunction, avoid continuous stimulation of estrogen.

Uterine hypertrophy complications Complications cervical erosion

Can be complicated by cervical erosion and so on.

Symptoms of uterine hypertrophy Common symptoms Menstrual volume Polycystic polyps Pregnancy uterus abnormally increased monocular or double-horned uterus

The main symptoms are excessive menstrual flow and prolonged days; there are also cases in which the cycle is shortened to about 20 days, and there is no significant change in the amount and duration of the day; or the menstrual period is prolonged, but the amount is not much.

Most of the patients are maternal, and most of them are more than 3 years old, the disease is long, the blood volume is more anemia, the gynecological examination of the uterus is evenly enlarged, generally 6 weeks of pregnancy size, a few more than 8 weeks of pregnancy size, the texture is tougher The bilateral ovaries can be slightly enlarged and there are multiple follicular cysts.

The basic pathological change of this disease is the changes of smooth muscle cells and blood vessel walls in the myometrium.

(1) Generally seen: the uterus is evenly enlarged, the muscle layer is 2.5-3.2 cm thick, the cut surface is grayish white or pink, the hardness is increased, the fiber bundle is arranged in a braided shape, and the outer 1/3 muscle layer is vascularized. The intima is normal or thickened, sometimes with small leiomyomas (less than 1 cm in diameter) or endometrial polyps.

(B) microscopic examination: the image is inconsistent, there are the following forms: 1 simple smooth muscle cell hypertrophy, microscopic observation and normal myometrial muscle layer, no collagen fiber proliferation, no significant changes in the blood vessel wall; 2 myometrial muscle layer Internal collagen fibers proliferate, forming uterine fibrosis; 3 changes in the blood vessel wall in the muscular layer: the arteries and veins are obviously dilated, and there is a cluster of elastic fiber proliferation around the new blood vessels.

Uterine hypertrophy check

Diagnostic curettage examination of the uterine cavity and B-ultrasound can be used for diagnosis, but there are still a few cases where laparotomy should be used to confirm the diagnosis. Diagnostic curettage is called a curettage. The purpose is to scrape the contents of the uterine cavity for pathological examination to assist diagnosis. If cervical lesions are suspected, it is necessary to perform stepwise treatment on the cervical canal and the uterine cavity. The diagnosis is divided into general diagnosis and sectional diagnosis. General diagnosis, for endocrine abnormalities need to understand endometrial changes and response to sex hormones, with or without ovulation, with or without tuberculosis. When the segmentation diagnosis is performed, the neck tube is scraped and the uterine cavity is scraped. The scrapings are sent to the pathological examination respectively. It is suitable for diagnosing cervical cancer, endometrial cancer and other uterine malignant tumors, and can understand the extent of the cancer.

Diagnosis and differentiation of uterine hypertrophy

diagnosis

Multi-partum women, menstrual area and uterus consistency increased, endometrial normal or thickening, individual polyps, but most of the pathological examination is normal, a small number of hyperplasia, can be diagnosed as uterine hypertrophy, should pay attention to uterine fibroids Identification, especially the muscle nucleus is a single wall or submucosal, when the uterus is evenly enlarged, it is often difficult to identify with uterine hypertrophy. Diagnosis and diagnosis can be assisted by uterine cavity and B-ultrasound examination, but there are still a few cases. Can be diagnosed when exploratory laparotomy.

Differential diagnosis

Should pay attention to the identification of diseases such as adenomyosis and endometrial cancer.

Adenomyosis is a common or gynecological disease in which endometrial glands and interstitial glands invade the myometrium to form diffuse or localized lesions. Adenomyosis has occurred in women over 40 years old, but it has gradually become younger in recent years, which may be related to the increase of cesarean section and abortion. There are many treatments for this disease, and clinical decision-making needs to be combined with the patient's age, symptoms and fertility requirements. And often combined with surgery, drugs and other comprehensive treatment options.

Endometrial Carcinoma is a group of epithelial malignancies that occur in the endometrium and occurs in perimenopausal and postmenopausal women. Endometrial cancer is one of the most common female reproductive system tumors, with nearly 200,000 new cases each year and the third most common gynaecological malignancy (secondary to ovarian and cervical cancer). Its incidence is closely related to lifestyle, and the incidence rate varies from region to region. Its incidence in North America and Europe is second only to breast cancer, lung cancer and colorectal cancer, and it ranks first among female reproductive system cancers. In China, with the development of society and the improvement of economic conditions, the incidence of endometrial cancer has also increased year by year, currently second only to cervical cancer, ranking second in female reproductive system malignancies.

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