子宮肌瘤:修订间差异

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約20%至80%的女性在50歲以前得過子宮肌瘤<ref name=Women2015/>。在2013年估計有1.71億的女性得到子宮肌瘤<ref name=GBD2015>{{cite journal|last1=Global Burden of Disease Study 2013|first1=Collaborators|title=Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.|journal=Lancet (London, England)|date=5 June 2015|pmid=26063472}}</ref>。一般會在生育年齡的中期或末期出現<!-- <ref name=Women2015/> -->,在[[停經]]後其尺寸會縮小<ref name=Women2015/>。在美國,子宮肌瘤是[[子宮切除術]]的常見原因之一<ref name=Wall2004>{{vcite2 journal | vauthors = Wallach EE, Vlahos NF | title = Uterine myomas: an overview of development, clinical features, and management | journal = Obstet Gynecol | volume = 104 | issue = 2 | pages = 393–406 | date = August 2004 | pmid = 15292018 | doi = 10.1097/01.AOG.0000136079.62513.39 }}</ref>。
約20%至80%的女性在50歲以前得過子宮肌瘤<ref name=Women2015/>。在2013年估計有1.71億的女性得到子宮肌瘤<ref name=GBD2015>{{cite journal|last1=Global Burden of Disease Study 2013|first1=Collaborators|title=Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.|journal=Lancet (London, England)|date=5 June 2015|pmid=26063472}}</ref>。一般會在生育年齡的中期或末期出現<!-- <ref name=Women2015/> -->,在[[停經]]後其尺寸會縮小<ref name=Women2015/>。在美國,子宮肌瘤是[[子宮切除術]]的常見原因之一<ref name=Wall2004>{{vcite2 journal | vauthors = Wallach EE, Vlahos NF | title = Uterine myomas: an overview of development, clinical features, and management | journal = Obstet Gynecol | volume = 104 | issue = 2 | pages = 393–406 | date = August 2004 | pmid = 15292018 | doi = 10.1097/01.AOG.0000136079.62513.39 }}</ref>。
{{trans H}}
==Signs and symptoms==
Some women with uterine fibroids do not have symptoms. Abdominal pain, anemia and increased bleeding can indicate the presence of fibroids.<ref name="mor2015"/> There may also be pain during intercourse, depending on the location of the fibroid. During [[pregnancy]], they may also be the cause of [[miscarriage]],<ref>{{cite book|title=Reproductive Surgery in Assisted Conception|date=2015|isbn=9781447149538|page=107|url=https://books.google.ca/books?id=GpVwCAAAQBAJ&pg=PA107}}</ref> bleeding, [[premature labor]], or interference with the position of the fetus.{{citation needed|date=June 2017}} A uterine fibroid can cause rectal pressure. The abdomen can grow larger mimicking the appearance of pregnancy.<ref name=Women2015/> Some large fibroids can extend out through the cervix and vagina.<ref name="mor2015"/>


While fibroids are common, they are not a typical cause for infertility, accounting for about 3% of reasons why a woman may not be able to have a child.<ref name=asrm>[http://www.asrm.org/Patients/patientbooklets/uterine_fibroids.pdf American Society of Reproductive Medicine Patient Booklet: ''Uterine Fibroids'', 2003]</ref> The majority of women with uterine fibroids will have normal pregnancy outcomes.<ref name="SegarsParrott2014">{{cite journal | vauthors = Segars JH, Parrott EC, Nagel JD, Guo XC, Gao X, Birnbaum LS, Pinn VW, Dixon D | title = Proceedings from the Third National Institutes of Health International Congress on Advances in Uterine Leiomyoma Research: comprehensive review, conference summary and future recommendations | journal = Human Reproduction Update | volume = 20 | issue = 3 | pages = 309–333 | year = 2014 | pmid = 24401287 | doi = 10.1093/humupd/dmt058 | pmc=3999378}}</ref><ref name="pmid24401287">{{cite journal | vauthors = Segars JH, Parrott EC, Nagel JD, Guo XC, Gao X, Birnbaum LS, Pinn VW, Dixon D | title = Proceedings from the Third National Institutes of Health International Congress on Advances in Uterine Leiomyoma Research: comprehensive review, conference summary and future recommendations | journal = Hum. Reprod. Update | volume = 20 | issue = 3 | pages = 309–33 | year = 2014 | pmid = 24401287 | pmc = 3999378 | doi = 10.1093/humupd/dmt058 }}</ref> In cases of intercurrent uterine fibroids in infertility, a fibroid is typically located in a submucosal position and it is thought that this location may interfere with the function of the lining and the ability of the embryo to [[Implantation (human embryo)|implant]].<ref name=asrm/>
==參考資料==

{{reflist}}
==Risk factors==
Some risk factors associated with the development of uterine fibroids are modifiable.<ref name=par2015/>
Fibroids are more common in obese women.<ref name=MM18/> Fibroids are dependent on estrogen and progesterone to grow and therefore relevant only during the reproductive years.

===Diet===
Diets high in fruits and vegetables tend to lower the risk of developing fibroids. Fruits, especially citrus, have a greater protective benefit than vegetables. Normal dietary levels of vitamin D is shown to reduce the risk of developing fibroids. No protective benefit has been found with the consumption of folate, whole grains, soy products, or fiber. No association between the consumption of fat, eggs, dairy products has been shown to increase the risk of fibroids.<ref name=par2015/>

===Genetics===
Fifty percent of uterine fibroids demonstrate a genetic abnormality. Often a translocation is found on some chromosomes.<ref name="mor2015"/> Fibroids are partly genetic. If a mother had fibroids, risk in the daughter is about three times higher than average.<ref>{{cite web|url= http://www.womenshealth.gov/publications/our-publications/fact-sheet/uterine-fibroids.html#d|title= Uterine fibroids fact sheet |publisher= womenshealth.gov}}</ref>

Researchers have completed profiling of global gene expression for uterine fibroids. They found that only a few specific genes or cytogenetic deviations are associated with fibroids.<ref>{{cite journal|last1=Medikare|first1=V|last2=Kandukuri|first2=LR|last3=Ananthapur|first3=V|last4=Deenadayal|first4=M|last5=Nallari|first5=P|title=The genetic bases of uterine fibroids; a review.|journal=Journal of reproduction & infertility|subscription=yes|date=July 2011|volume=12|issue=3|pages=181–91|pmid=23926501|pmc=3719293}}</ref>

80-85% of fibroids have a mutation in the mediator complex subunit 12 ([[MED12]]) gene.<ref>{{cite journal | vauthors = Kämpjärvi K, Park MJ, Mehine M, Kim NH, Clark AD, Bützow R, Böhling T, Böhm J, Mecklin JP, Järvinen H, Tomlinson IP, van der Spuy ZM, Sjöberg J, Boyer TG, Vahteristo P | title = Mutations in Exon 1 highlight the role of MED12 in uterine leiomyomas | journal = Human Mutation | volume = 35 | issue = 9 | pages = 1136–41 | date = Sep 2014 | pmid = 24980722 | doi = 10.1002/humu.22612 }}</ref><ref name=Heinonen2017>Heinonen HR, Pasanen A, Heikinheimo O, Tanskanen T, Palin K, Tolvanen J, Vahteristo P, Sjöberg J, Pitkänen E, Bützow R, Mäkinen N, Aaltonen LA (2017) Multiple clinical characteristics separate MED12-mutation-positive and -negative uterine leiomyomas. Sci Rep 7(1):1015. {{doi|10.1038/s41598-017-01199-0}}.</ref>

===Familial leiomyomata===
{{details|Hereditary leiomyomatosis and renal cell cancer}}

A syndrome ([[Reed's syndrome]]) that causes uterine leiomyomata along with cutaneous leiomyomata and [[renal cell cancer]] has been reported.<ref name=Tolvanen2012>{{cite journal | vauthors = Tolvanen J, Uimari O, Ryynänen M, Aaltonen LA, Vahteristo P | title = Strong family history of uterine leiomyomatosis warrants fumarate hydratase mutation screening | journal = Human Reproduction | volume = 27 | issue = 6 | pages = 1865–9 | year = 2012 | pmid = 22473397 | pmc = | doi = 10.1093/humrep/des105 }}</ref><ref name=Toro2003>{{cite journal | vauthors = Toro JR, Nickerson ML, Wei MH, Warren MB, Glenn GM, Turner ML, Stewart L, Duray P, Tourre O, Sharma N, Choyke P, Stratton P, Merino M, Walther MM, Linehan WM, Schmidt LS, Zbar B | title = Mutations in the fumarate hydratase gene cause hereditary leiomyomatosis and renal cell cancer in families in North America | journal = Am J Hum Genet | volume = 73 | issue = 1 | pages = 95–106 | year = 2003 | pmid = 12772087 | pmc = 1180594 | doi = 10.1086/376435 | displayauthors = 1 }}</ref><ref>http://rarediseases.info.nih.gov/GARD/Condition/10160/Reed_syndrome.aspx{{full citation needed|date=October 2014}}</ref> This is associated with a mutation in the gene that produces the enzyme [[fumarate hydratase]], located on the long arm of [[chromosome 1]] (1q42.3-43). Inheritance is [[Dominance (genetics)|autosomal dominant]].

==Pathophysiology==
[[File:leiomyoma.jpg|thumb|An enucleated uterine leiomyoma – external surface on left, cut surface on right.]]
Fibroids are a type of uterine [[leiomyoma]]. Fibroids grossly appear as round, well circumscribed (but not encapsulated), solid nodules that are white or tan, and show whorled appearance on histological section. The size varies, from microscopic to lesions of considerable size. Typically lesions the size of a grapefruit or bigger are felt by the patient herself through the abdominal wall.<ref name=Women2015/>

[[File:Lipoleiomyoma2.jpg|thumb|right|[[Micrograph]] of a lipoleiomyoma, a type of leiomyoma. [[H&E stain]].]]
Microscopically, tumor cells resemble normal cells (elongated, spindle-shaped, with a cigar-shaped nucleus) and form bundles with different directions (whorled). These cells are uniform in size and shape, with scarce mitoses. There are three benign variants: bizarre (atypical); cellular; and [[Mitosis|mitotically]] active.

The appearance of prominent nucleoli with perinucleolar halos should alert the pathologist to investigate the possibility of the extremely rare hereditary leiomyomatosis and renal cell cancer (Reed) syndrome.<ref name=Garg_2011>{{cite journal | vauthors = Garg K, Tickoo SK, Soslow RA, Reuter VE | title = Morphologic Features of Uterine Leiomyomas Associated with Hereditary Leiomyomatosis and Renal Cell Carcinoma Syndrome | journal = The American Journal of Surgical Pathology | volume = 35 | issue = 8 | pages = 1235–1237 | year = 2011 | pmid = 21753700 | pmc = | doi = 10.1097/PAS.0b013e318223ca01 }}</ref>

===Location and classification===
[[File:Uterine fibroids.png|thumb|Schematic drawing of various types of uterine fibroids: a=subserosal fibroids, b=intramural fibroids, c=submucosal fibroid, d=pedunculated submucosal fibroid, e=fibroid in statu nascendi, f=fibroid of the broad ligament]]
Growth and location are the main factors that determine if a fibroid leads to symptoms and problems.<ref name=Wall2004/> A small lesion can be symptomatic if located within the uterine cavity while a large lesion on the outside of the uterus may go unnoticed. Different locations are classified as follows:
* '''Intramural fibroids''' are located within the muscular wall of the uterus and are the most common type. Unless they are large, they may be asymptomatic. Intramural fibroids begin as small nodules in the muscular wall of the uterus. With time, intramural fibroids may expand inwards, causing distortion and elongation of the uterine cavity.
* '''Subserosal fibroids''' are located on the surface of the uterus. They can also grow outward from the surface and remain attached by a small piece of tissue and then are called pedunculated fibroids.<ref name="Women2015"/> These pedunculated growths can actually detach from the uterus to become a parasitic leiomyoma.{{Citation needed|date=June 2017}}
* '''Submucosal fibroids''' are located in the muscle beneath the endometrium of the uterus and distort the uterine cavity; even small lesions in this location may lead to bleeding and [[infertility]]. A pedunculated lesion within the cavity is termed an intracavitary fibroid and can be passed through the cervix.
* '''Cervical fibroids''' are located in the wall of the cervix (neck of the uterus). Rarely, fibroids are found in the supporting structures ([[Round ligament of uterus|round ligament]], [[broad ligament]], or [[uterosacral ligament]]) of the uterus that also contain smooth muscle tissue.

Fibroids may be single or multiple. Most fibroids start in the muscular wall of the uterus. With further growth, some lesions may develop towards the outside of the uterus or towards the internal cavity. Secondary changes that may develop within fibroids are hemorrhage, necrosis, calcification, and cystic changes. They tend to calcify after menopause.<ref>{{cite book|last1=Impey|first1=Lawrence|last2=Child|first2=Tim|title=Obstetrics and Gynaecology|date=2016|publisher=John Wiley & Sons|location=24|isbn=9781119010807|url=https://books.google.ca/books?id=STFtDQAAQBAJ&pg=PA24|language=en}}</ref>

If the uterus contains too many to count, it is referred to as ''diffuse uterine leiomyomatosis''.

====Extrauterine fibroids of uterine origin, metastatic fibroids====
Fibroids of uterine origin located in other parts of the body, sometimes also called parasitic myomas have been historically extremely rare, but are now diagnosed with increasing frequency. They may be related or identical to metastasizing [[leiomyoma]].

They are in most cases still hormone dependent but may cause life-threatening complications when they appear in distant organs. Some sources suggest that a substantial share of the cases may be late complications of surgeries such as myomectomy or hysterectomy. Particularly laparoscopic myomectomy using a morcellator has been associated with a substantially increased risk of this complication.<ref name=Cucinella_2011>{{cite journal | vauthors = Cucinella G, Granese R, Calagna G, Somigliana E, Perino A | title = Parasitic myomas after laparoscopic surgery: An emerging complication in the use of morcellator? Description of four cases | journal = Fertility and Sterility | volume = 96 | issue = 2 | pages = e90–e96 | year = 2011 | pmid = 21719004 | pmc = | doi = 10.1016/j.fertnstert.2011.05.095 }}</ref><ref name=Netzhat_2010>{{cite journal | vauthors = Nezhat C, Kho K | title = Iatrogenic Myomas: New Class of Myomas? | journal = Journal of Minimally Invasive Gynecology | volume = 17 | issue = 5 | pages = 544–550 | year = 2010 | pmid = 20580324 | pmc = | doi = 10.1016/j.jmig.2010.04.004 }}</ref>

There are a number of rare conditions in which fibroids metastasize. They still grow in a benign fashion, but can be dangerous depending on their location.<ref name="ReferenceA">{{cite book |title=Fletcher's Diagnostic Histopathology of Tumors |pages=692–4 |edition=3rd }}</ref>
*In leiomyoma with vascular invasion, an ordinary-appearing fibroid invades into a vessel but there is no risk of recurrence.
*In [[intravenous leiomyomatosis]], leiomyomata grow in veins with uterine fibroids as their source. Involvement of the heart can be fatal.
*In benign metastasizing leiomyoma, leiomyomata grow in more distant sites such as the lungs and lymph nodes. The source is not entirely clear. Pulmonary involvement can be fatal.
*In disseminated intraperitoneal leiomyomatosis, leiomyomata grow diffusely on the peritoneal and omental surfaces, with uterine fibroids as their source. This can simulate a malignant tumor but behaves benignly.

===Pathogenesis===
[[File:Multiple uterine leiomyoma.jpg|thumb|Multiple uterine leiomyoma]]
[[File:Myom.jpg|thumb|Large subserosal fibroid]]
[[file:Multiple uterine leiomyoma with calcification.jpg|thumb|Multiple uterine leiomyoma with calcification]]
Fibroids are [[monoclonal]] tumors and approximately 40 to 50% show [[karyotype|karyotypically]] detectable [[chromosome abnormalities|chromosomal abnormalities]]. When multiple fibroids are present they frequently have unrelated genetic defects. Specific mutations of the [[MED12]] protein have been noted in 70 percent of fibroids.<ref name="Mäkinen_2011">{{cite journal | vauthors = Mäkinen N, Mehine M, Tolvanen J, Kaasinen E, Li Y, Lehtonen HJ, Gentile M, Yan J, Enge M, Taipale M, Aavikko M, Katainen R, Virolainen E, Böhling T, Koski TA, Launonen V, Sjöberg J, Taipale J, Vahteristo P, Aaltonen LA | title = MED12, the Mediator Complex Subunit 12 Gene, is Mutated at High Frequency in Uterine Leiomyomas | journal = Science | volume = 334 | issue = 6053 | pages = 252–255 | year = 2011 | pmid = 21868628 | doi = 10.1126/science.1208930 | bibcode = 2011Sci...334..252M }}</ref>

The exact cause of fibroids is not clearly understood, but the current working hypothesis is that genetic predispositions, prenatal hormone exposure and the effects of hormones, growth factors and [[xenoestrogens]] cause fibroid growth. Known risk factors are African descent, [[obesity]], [[polycystic ovary syndrome]], [[diabetes]], [[hypertension]], and [[nulliparity|never having given birth]].<ref name=Okolo_2008>{{cite journal | vauthors = Okolo S | title = Incidence, aetiology and epidemiology of uterine fibroids | journal = Best practice & research. Clinical obstetrics & gynaecology | volume = 22 | issue = 4 | pages = 571–588 | year = 2008 | pmid = 18534913 | doi = 10.1016/j.bpobgyn.2008.04.002 }}</ref>

It is believed that estrogen and progesterone have a [[mitogenic]] effect on leiomyoma cells and also act by influencing (directly and indirectly) a large number of [[growth factor]]s, [[cytokine]]s and apoptotic factors as well as other hormones. Furthermore, the actions of estrogen and progesterone are modulated by the cross-talk between estrogen, progesterone and [[prolactin]] signaling which controls the expression of the respective nuclear receptors. It is believed that estrogen promotes growth by up-regulating [[IGF-1]], [[Epidermal growth factor receptor|EGFR]], [[TGF-beta| TGF-beta1]], TGF-beta3 and [[PDGF]], and promotes aberrant survival of leiomyoma cells by down-regulating [[p53]], increasing expression of the anti-apoptotic factor [[PCP4]] and antagonizing [[PPAR-gamma]] signaling. Progesterone is thought to promote the growth of leiomyoma through up-regulating [[Epidermal growth factor|EGF]], TGF-beta1 and TGF-beta3, and promotes survival through up-regulating [[Bcl-2]] expression and down-regulating [[TNF-alpha]]. Progesterone is believed to counteract growth by downregulating IGF-1.<ref name="Wei_2007">{{cite journal | vauthors = Maruo T, Ohara N, Wang J, Matsuo H | title = Sex steroidal regulation of uterine leiomyoma growth and apoptosis | journal = Human Reproduction Update | volume = 10 | issue = 3 | pages = 207–220 | year = 2004 | pmid = 15140868 | doi = 10.1093/humupd/dmh019 }}</ref> Expression of [[transforming growth interacting factor]] (TGIF) is increased in leiomyoma compared with myometrium.<ref name=Yen-Ping>{{cite journal | vauthors = Yen-Ping Ho J, Man WC, Wen Y, Polan ML, Shih-Chu Ho E, Chen B | title = Transforming growth interacting factor expression in leiomyoma compared with myometrium | journal = Fertil. Steril. | volume = 94 | issue = 3 | pages = 1078–83 | date = June 2009 | pmid = 19524896 | pmc = 2888713 | doi = 10.1016/j.fertnstert.2009.05.001 }}</ref> TGIF is a potential repressor of [[TGF-β]] pathways in myometrial cells.<ref name=Yen-Ping/>

Aromatase and 17beta-hydroxysteroid dehydrogenase are aberrantly expressed in fibroids, indicating that fibroids can convert circulating androstenedione into estradiol.<ref>{{cite journal | vauthors = Shozu M, Murakami K, Inoue M | title = Aromatase and Leiomyoma of the Uterus | journal = Seminars in Reproductive Medicine | volume = 22 | issue = 1 | pages = 51–60 | year = 2004 | pmid = 15083381 | doi = 10.1055/s-2004-823027 }}</ref> Similar mechanism of action has been elucidated in [[endometriosis]] and other endometrial diseases.<ref>{{cite journal |author-link1=Serdar Bulun | vauthors =Bulun SE, Yang S, Fang Z, Gurates B, Tamura M, Zhou J, Sebastian S | title = Role of aromatase in endometrial disease | journal = The Journal of Steroid Biochemistry and Molecular Biology | volume = 79 | issue = 1–5 | pages = 19–25 | year = 2001 | pmid = 11850203 | doi = 10.1016/S0960-0760(01)00134-0 }}</ref> Aromatase inhibitors are currently considered for treatment, at
certain doses they would completely inhibit estrogen production in the fibroid while not largely affecting ovarian production of estrogen (and thus systemic levels of it).<!--merge that part with treatment section later--> Aromatase overexpression is particularly pronounced in African-American women.<ref name="MoravekYin2014">{{cite journal|last1=Moravek|first1=MB|last2=Yin|first2=P|last3=Ono|first3=M|last4=Coon|first4=JS|last5=Dyson|first5=MT|last6=Navarro|first6=A|last7=Marsh|first7=EE|last8=Chakravarti|first8=D|last9=Kim|first9=JJ|last10=Wei|first10=JJ|last11=Bulun|first11=SE|title=Ovarian steroids, stem cells and uterine leiomyoma: therapeutic implications| journal=Human Reproduction Update|volume=21|issue=1|pages= 1–12|date=February 2015|pmid=25205766|pmc=4255606|doi=10.1093/humupd/dmu048|type=Review}}</ref>

Genetic and hereditary causes are being considered and several epidemiologic findings indicate considerable genetic influence especially for early onset cases. First degree relatives have a 2.5-fold risk, and nearly 6-fold risk when considering early onset cases. [[Monozygotic twins]] have double concordance rate for hysterectomy compared to [[dizygotic twins]].<ref>{{cite journal | vauthors = Hodge JC, Morton CC | title = Genetic heterogeneity among uterine leiomyomata: insights into malignant progression | journal = Human Molecular Genetics | volume = 16 Spec No 1 | pages = R7–13 | year = 2007 | pmid = 17613550 | doi = 10.1093/hmg/ddm043 }}</ref>

Expansion of uterine fibroids occurs by a slow rate of cell proliferation combined with the production of copious amounts of [[extracellular matrix]].<ref name="MoravekYin2014"/>

A small population of the cells in a uterine fibroid have properties of [[stem cell]]s or [[progenitor cell]]s, and contribute significantly to [[ovarian steroid]]-dependent growth of fibroids. These stem-progenitor cells are deficient in estrogen receptor α and progesterone receptor and instead rely on substantially higher levels of these receptors in surrounding differentiated cells to mediate estrogen and progesterone actions via [[paracrine signaling]].<ref name="MoravekYin2014"/>

==Diagnosis==
The presence of a uterine fibroid versus an adnexal tumor is made. Fibroids can be mistaken for ovarian neoplasms. An uncommon tumor which may be mistaken for a fibroid is Sarcoma botryoides. It is more common in children and adolescents. Like a fibroid, it can also protrude from the vagina and is distinguished from fibroids.<ref name="mor2015"/> While [[palpation]] used in a [[pelvic examination]] can typically identify the presence of larger fibroids, [[gynecologic ultrasonography]] (ultrasound) has evolved as the standard tool to evaluate the uterus for fibroids. Sonography will depict the fibroids as focal masses with a heterogeneous texture, which usually cause shadowing of the ultrasound beam. The location can be determined and dimensions of the lesion measured. Also, magnetic resonance imaging ([[MRI]]) can be used to define the depiction of the size and location of the fibroids within the uterus.{{citation needed|date=June 2017}}

Imaging modalities cannot clearly distinguish between the benign uterine leiomyoma and the malignant uterine leiomyosarcoma, however, the latter is quite rare. Fast growth or unexpected growth, such as enlargement of a lesion after menopause, raise the level of suspicion that the lesion might be a sarcoma. Also, with advanced malignant lesions, there may be evidence of local invasion. A biopsy is rarely performed and if performed, is rarely diagnostic. Should there be an uncertain diagnosis after ultrasounds and MRI imaging, surgery is generally indicated.{{citation needed|date=June 2017}}

Other imaging techniques that may be helpful specifically in the evaluation of lesions that affect the uterine cavity are [[hysterosalpingography]] or [[sonohysterography]].{{citation needed|date=June 2017}}
<gallery>
File:9cmFibroidPelvicCongestionS.png|A very large (9&nbsp;cm) fibroid of the uterus which is causing [[pelvic congestion syndrome]] as seen on CT
File:9cmFibroidUS.png|A very large (9&nbsp;cm) fibroid of the uterus which is causing pelvic congestion syndrome as seen on [[ultrasound]]
File:Leiomyoma of the Uterus.jpg|A relatively large submucosal leiomyoma; it fills out the major part of the endometrial cavity
File:UterineFirboid.png|A small uterine fibroid seen within the wall of the [[myometrium]] on a cross-sectional ultrasound view
File:Calcifiedfibroids.PNG|Two calcified fibroids (in the uterus)
File:Subserosal uterine fibroid.png|thumb|A subserosal uterine fibroid with a diameter of 5 centimeters.
</gallery>

===Coexisting disorders===
Fibroids that lead to heavy vaginal bleeding lead to [[anemia]] and [[Iron deficiency (medicine)|iron deficiency]]. Due to pressure effects gastrointestinal problems such as [[constipation]] and bloatedness are possible. Compression of the ureter may lead to [[hydronephrosis]]. Fibroids may also present alongside [[endometriosis]], which itself may cause infertility. [[Adenomyosis]] may be mistaken for or coexist with fibroids.

In very rare cases, malignant (cancerous) growths, [[leiomyosarcoma]], of the myometrium can develop.<ref name="urlFibroids - NHS Choices">{{cite web | url = http://www.nhs.uk/Conditions/Fibroids/Pages/Introduction.aspx?url=Pages/What-is-it.aspx | title = Fibroids | publisher = U.K. National Health Service | work = NHS Choices | accessdate = }}</ref> In extremely rare cases uterine fibroids may present as part or early symptom of the [[hereditary leiomyomatosis and renal cell cancer]] syndrome.

==Treatment==
Most fibroids do not require treatment unless they are causing symptoms. After menopause fibroids shrink and it is unusual for them to cause problems.

Symptomatic uterine fibroids can be treated by:
* medication to control symptoms
* medication aimed at shrinking tumors
* ultrasound fibroid destruction
* myomectomy or radio frequency ablation
* hysterectomy
* uterine artery embolization

In those who have symptoms [[uterine artery embolization]] and surgical options have similar outcomes with respect to satisfaction.<ref>{{cite journal | vauthors = Gupta JK, Sinha A, Lumsden MA, Hickey M | title = Uterine artery embolization for symptomatic uterine fibroids. | journal = The Cochrane database of systematic reviews | volume = 12 | pages = CD005073 | date = 26 December 2014 | pmid = 25541260 | doi=10.1002/14651858.CD005073.pub4}}</ref>

===Medication===
A number of medications may be used to control symptoms. [[Non-steroidal anti-inflammatory drug|NSAID]]s can be used to reduce painful menstrual periods. Oral contraceptive pills may be prescribed to reduce uterine bleeding and cramps.<ref name=asrm/> Anemia may be treated with iron supplementation.

[[IUD with progestogen|Levonorgestrel intrauterine devices]] are effective in limiting menstrual blood flow and improving other symptoms. Side effects are typically few as the [[levonorgestrel]] (a [[progestin]]) is released in low concentration locally.<ref name=Zapata_2010>{{cite journal | vauthors = Zapata LB, Whiteman MK, Tepper NK, Jamieson DJ, Marchbanks PA, Curtis KM | title = Intrauterine device use among women with uterine fibroids: a systematic review☆ | journal = Contraception | volume = 82 | issue = 1 | pages = 41–55 | year = 2010 | pmid = 20682142 | pmc = | doi = 10.1016/j.contraception.2010.02.011 }}</ref> While most levongestrel-IUD studies concentrated on treatment of women without fibroids a few reported good results specifically for women with fibroids including a substantial regression of fibroids.<ref name=Sankaran_2008 /><ref>{{cite journal | vauthors = Kailasam C, Cahill D | title = Review of the safety, efficacy and patient acceptability of the levonorgestrel-releasing intrauterine system | journal = Patient preference and adherence | volume = 2 | issue = | pages = 293–302 | year = 2008 | pmid = 19920976 | pmc = 2770406 | doi = 10.2147/ppa.s3464 }}</ref>

[[Cabergoline]] in a moderate and well-tolerated dose has been shown in two studies to shrink fibroids effectively. The mechanism of action responsible for how cabergoline shrinks fibroids is unclear.<ref name=Sankaran_2008 />

[[Ulipristal acetate]] is a synthetic [[selective progesterone receptor modulator]] (SPRM) that has tentative evidence to support its use for presurgical treatment of fibroids with low side-effects.<ref>{{cite journal|last1=Talaulikar|first1=VS|last2=Manyonda|first2=IT|title=Ulipristal acetate: a novel option for the medical management of symptomatic uterine fibroids.|journal=Advances in therapy|date=August 2012|volume=29|issue=8|pages=655–63|pmid=22903240|doi=10.1007/s12325-012-0042-8}}</ref> Long-term UPA-treated fibroids have shown volume reduction of about 70%.<ref>{{cite journal|last1=Pérez-López|first1=FR|title=Ulipristal acetate in the management of symptomatic uterine fibroids: facts and pending issues.|journal=Climacteric : the journal of the International Menopause Society|date=April 2015|volume=18|issue=2|pages=177–81|pmid=25390187|doi=10.3109/13697137.2014.981133}}</ref> In some cases UPA alone is used to relieve symptoms without surgery.<ref name="mor2015"/>

[[Danazol]] is an effective treatment to shrink fibroids and control symptoms. Its use is limited by unpleasant side effects. Mechanism of action is thought to be antiestrogenic effects. Recent experience indicates that safety and side effect profile can be improved by more cautious dosing.<ref name=Sankaran_2008 />

[[Gonadotropin-releasing hormone analog]]s cause temporary regression of fibroids by decreasing estrogen levels. Because of the limitations and side effects of this medication, it is rarely recommended other than for preoperative use to shrink the size of the fibroids and uterus before surgery. It is typically used for a maximum of 6 months or less because after longer use they could cause [[osteoporosis]] and other typically postmenopausal complications. The main side effects are transient postmenopausal symptoms. In many cases the fibroids will regrow after cessation of treatment, however, significant benefits may persist for much longer in some cases. Several variations are possible, such as GnRH agonists with add-back regimens intended to decrease the adverse effects of estrogen deficiency. Several add-back regimes are possible, [[tibolone]], [[raloxifene]], [[progestogens]] alone, [[estrogen]] alone, and combined estrogens and progestogens.<ref name=Sankaran_2008>{{cite journal | vauthors = Sankaran S, Manyonda IT | title = Medical management of fibroids | journal = Best Pract Res Clin Obstet Gynaecol | volume = 22 | issue = 4 | pages = 655–76 | year = 2008 | pmid = 18468953 | doi = 10.1016/j.bpobgyn.2008.03.001 | url = http://www.britishfibroidtrust.org.uk/journals/bft_Sankaran.pdf }}</ref>

[[Progesterone]] antagonists such as [[mifepristone]] have been tested, there is evidence that it relieves some symptoms and improves quality of life but because of adverse histological changes that have been observed in several trials it can not be currently recommended outside of research setting.<ref name=Tristan_2012>{{cite journal | vauthors = Tristan M, Orozco LJ, Steed A, Ramírez-Morera A, Stone P | journal = Cochrane database of systematic reviews (Online) | volume = 8 | pages = CD007687 | year = 2012 | pmid = 22895965 | pmc = | doi = 10.1002/14651858.CD007687.pub2 | title = Mifepristone for uterine fibroids | editor1-last = Orozco | editor1-first = Leonardo J }}</ref><ref>{{cite journal | vauthors = Malartic C, Morel O, Akerman G, Tulpin L, Desfeux P, Barranger E | title = La mifépristone dans la prise en charge des fibromes utérins | journal = Gynécologie Obstétrique & Fertilité | volume = 36 | issue = 6 | pages = 668–74 | year = 2008 | pmid = 18539512 | doi = 10.1016/j.gyobfe.2008.01.017 }}</ref> Fibroid growth has recurred after antiprogestin treatment was stopped.<ref name="MoravekYin2014"/>

[[Aromatase inhibitor]]s have been used experimentally to reduce fibroids. The effect is believed to be due partially by lowering systemic estrogen levels and partially by inhibiting locally overexpressed aromatase in fibroids.<ref name=Sankaran_2008 /> However, fibroid growth has recurred after treatment was stopped.<ref name="MoravekYin2014"/> Experience from experimental aromatase inhibitor treatment of [[endometriosis]] indicates that aromatase inhibitors might be particularly useful in combination with a progestogenic ovulation inhibitor.

===Uterine artery===
[[Uterine artery embolization]] (UAE) is a noninvasive procedure that blocks of blood flow to fibroids and thus can treat them.<ref name="urlThe Embolisation Process">{{cite web | url = http://femisa.org.uk/index.php/treatment-options/embolisation/whats-involved | title = The Embolisation Process | publisher = FEmISA: Fibroid Embolisation: Information, Support, Advice }}</ref> Long term outcomes with respect to how happy people are with the procedure are similar to that of surgery.<ref name=Gupta2014/> There is tentative evidence that traditional surgery may result in better fertility.<ref name=Gupta2014/> One review found that UAE doubles the future risk of [[miscarriage]].<ref>{{cite journal|last1=Homer|first1=Hayden|last2=Saridogan|first2=Ertan|title=Uterine artery embolization for fibroids is associated with an increased risk of miscarriage|journal=Fertility and Sterility|date=June 2010|volume=94|issue=1|pages=324–330|pmid=19361799|doi=10.1016/j.fertnstert.2009.02.069|url=http://ac.els-cdn.com/S0015028209004968/1-s2.0-S0015028209004968-main.pdf?_tid=c236d16c-f8e4-11e4-8cee-00000aab0f6b&acdnat=1431462392_be391d491b9a2667021a2d48e9ef2704|type=Systematic review|accessdate=12 May 2015}}</ref> UAE also appears to require more repeat procedures than if surgery was done initially.<ref name=Gupta2014>{{cite journal|last1=Gupta|first1=JK|last2=Sinha|first2=A|last3=Lumsden|first3=MA|last4=Hickey|first4=M|title=Uterine artery embolization for symptomatic uterine fibroids.|journal=The Cochrane database of systematic reviews|date=26 December 2014|volume=12|pages=CD005073|pmid=25541260|doi=10.1002/14651858.CD005073.pub4}}</ref> A person will usually recover from the procedure within a few days.

Uterine artery ligation, sometimes also laparoscopic occlusion of uterine arteries are minimally invasive methods to limit blood supply of the uterus by a small surgery that can be performed transvaginally or laparoscopically. The principal mechanism of action may be similar like in UAE but is easier to perform and fewer side effects are expected.<ref>{{cite journal | vauthors = Liu WM, Ng HT, Wu YC, Yen YK, Yuan CC | title = Laparoscopic bipolar coagulation of uterine vessels: a new method for treating symptomatic fibroids | journal = Fertility and Sterility | volume = 75 | issue = 2 | pages = 417–22 | year = 2001 | pmid = 11172850 | doi = 10.1016/S0015-0282(00)01724-6 }}</ref>{{Primary source inline|date=May 2015}}<ref>{{cite journal | vauthors = Akinola OI, Fabamwo AO, Ottun AT, Akinniyi OA | title = Uterine artery ligation for management of uterine fibroids | journal = International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics | volume = 91 | issue = 2 | pages = 137–40 | year = 2005 | pmid = 16168993 | doi = 10.1016/j.ijgo.2005.07.012 }}</ref>{{Primary source inline|date=May 2015}}

===Myomectomy===
[[File:Myoma.jpg|thumb|Submucosal fibroid in [[hysteroscopy]]]]
[[File:Myomenukleation.jpg|thumb|Treatment of an intramural fibroid by [[laparoscopic surgery]]]][[File:Myomenukleation1.jpg|thumb|After treatment of an intramural fibroid by [[laparoscopic surgery]]]]

Myomectomy is a surgery to remove one or more fibroids. It is usually recommended when more conservative treatment options fail for women who want fertility preserving surgery or who want to retain the uterus.<ref name=Metwally_2012>{{cite journal | vauthors = Metwally M, Cheong YC, Horne AW | journal = Cochrane database of systematic reviews (Online) | volume = 11 | pages = CD003857 | year = 2012 | pmid = 23152222 | pmc = | doi = 10.1002/14651858.CD003857.pub3 | title = Surgical treatment of fibroids for subfertility | editor1-last = Metwally | editor1-first = Mostafa }}</ref>
There are three types of myomectomy:
* In a ''[[hysteroscopy|hysteroscopic]]'' myomectomy (also called ''trans[[Cervix|cervical]] resection''), the fibroid can be removed by either the use of a resectoscope, an [[endoscopy|endoscopic]] instrument inserted through the vagina and cervix that can use high-frequency electrical energy to cut tissue, or a similar device.
* A ''[[laparoscopy|laparoscopic]]'' myomectomy is done through a small incision near the navel. The physician uses a laparoscope and surgical instruments to remove the fibroids. Studies have suggested that laparoscopic myomectomy leads to lower [[morbidity]] rates and faster recovery than does laparotomic myomectomy.<ref>{{cite journal | vauthors = Agdi M, Tulandi T | title = Endoscopic management of uterine fibroids | journal = Best Pract Res Clin Obstet Gynaecol | volume = 22 | issue = 4 | pages = 707–16 | date = August 2008 | pmid = 18325839 | doi = 10.1016/j.bpobgyn.2008.01.011 }}</ref>
* A ''[[laparotomy|laparotomic]]'' myomectomy (also known as an ''open'' or ''abdominal'' myomectomy) is the most invasive surgical procedure to remove fibroids. The physician makes an incision in the abdominal wall and removes the fibroids from the uterus.

Laparoscopic myomectomy has less pain and shorter time in hospital than open surgery.<ref>{{cite journal | vauthors = Bhave Chittawar P, Franik S, Pouwer AW, Farquhar C | title = Minimally invasive surgical techniques versus open myomectomy for uterine fibroids. | journal = The Cochrane database of systematic reviews | volume = 10 | pages = CD004638 | date = Oct 21, 2014 | pmid = 25331441 | doi = 10.1002/14651858.CD004638.pub3 }}</ref>

===Hysterectomy===
[[Hysterectomy]] was the classical method of treating fibroids. Although it is now recommended only as last option, fibroids are still the leading cause of hysterectomies in the US.

===Endometrial ablation===
[[Endometrial ablation]] can be used if the fibroids are only within the uterus and not intramural and relatively small. High failure and recurrence rates are expected in the presence of larger or intramural fibroids.

===Other procedures===
[[Radiofrequency ablation]] is a minimally invasive treatments for fibroids.<ref>{{cite news| url = https://online.wsj.com/news/articles/SB10001424052748704541004575010933671115028 | work=The Wall Street Journal | title=A New Treatment to Help Women Avoid Hysterectomy | date=2010-01-20 | first=Melinda | last=Beck}}</ref> In this technique the fibroid is shrunk by inserting a needle-like device into the fibroid through the abdomen and heating it with radio-frequency (RF) electrical energy to cause [[necrosis]] of cells. The treatment is a potential option for women who have fibroids, have completed child-bearing and want to avoid a hysterectomy.

[[Magnetic resonance guided focused ultrasound]], is a non-invasive intervention (requiring no incision) that uses high intensity focused [[ultrasound]] waves to destroy tissue in combination with [[magnetic resonance imaging]] (MRI), which guides and monitors the treatment. During the procedure, delivery of focused ultrasound energy is guided and controlled using MR thermal imaging.<ref>{{cite press release |title=FDA Approves New Device to Treat Uterine Fibroids |publisher=FDA |date=2004-10-22 |url=http://www.fda.gov/bbs/topics/answers/2004/ans01319.html |accessdate=2008-05-26}}</ref> Patients who have symptomatic fibroids, who desire a non-invasive treatment option and who do not have contraindications for MRI are candidates for MRgFUS. About 60% of patients qualify. It is an outpatient procedure and takes one to three hours depending on the size of the fibroids. It is safe and about 75% effective.<ref>{{cite journal | authors = Shen SH, Fennessy F, McDannold N, Jolesz F, Tempany C | title = Image-guided thermal therapy of uterine fibroids | journal = Seminars in ultrasound, CT, and MR | volume = 30 | issue = 2 | pages = 91–104 | date = April 2009 | pmid = 19358440 | pmc = 2768544 | doi = 10.1053/j.sult.2008.12.002 }}</ref> Symptomatic improvement is sustained for two plus years.<ref>{{cite journal | vauthors = Stewart EA, Rabinovici J, Tempany CM, Inbar Y, Regan L, Gostout B, Gastout B, Hesley G, Kim HS, Hengst S, Gedroyc WM, Gedroye WM | title = Clinical outcomes of focused ultrasound surgery for the treatment of uterine fibroids | journal = Fertil. Steril. | volume = 85 | issue = 1 | pages = 22–9 | date = January 2006 | pmid = 16412721 | doi = 10.1016/j.fertnstert.2005.04.072 }}</ref> Need for additional treatment varies from 16-20% and is largely dependent on the amount of fibroid that can be safely ablated; the higher the ablated volume, the lower the re-treatment rate.<ref>{{cite journal | authors = Kurashvili J, Stepanov A, Kulabuchova E, Batarshina O | title = MRgFUS for Uterine Myomas: Safety, Effectiveness and Pathogenesis | journal = Journal of Therapeutic Ultrasound | year = 2014 | volume = 2 | issue = Suppl 1 | pages = A1 | doi = 10.1186/2050-5736-2-S1-A1 }}</ref> There are currently no randomized trial between MRgFUS and UAE. A multi-center trial is underway to investigate the efficacy of MRgFUS vs. UAE.

==Prognosis==
About 1 out of 1000 lesions are or become malignant, typically as a [[leiomyosarcoma]] on histology.<ref name=asrm/> A sign that a lesion may be malignant is growth after [[menopause]].<ref name=asrm/> There is no consensus among pathologists regarding the transformation of [[leiomyoma]] into a sarcoma.

===Metastasis===
There are a number of rare conditions in which fibroids metastasize. They still grow in a benign fashion, but can be dangerous depending on their location.<ref name="ReferenceA"/>

See [[Uterine fibroid#Extrauterine fibroids of uterine origin, metastatic fibroids|extrauterine fibroids]].

==Epidemiology==
About 20% to 80% of women develop fibroids by the age of 50.<ref name=par2015/><ref name=Women2015/> Globally in 2013 it was estimated that 171 million women were affected.<ref name=GBD2015/> They are typically found during the middle and later reproductive years.<ref name=Women2015/> After [[menopause]] they usually decrease in size.<ref name=Women2015/> Surgery to remove uterine fibroids occurs more frequently in women in "higher social classes".<ref name = par2015/> Adolescents develop unterine fibroids much less frequently than older women.<ref name="mor2015">{{cite journal|last1=Moroni|first1=Rafael Mendes|last2=Vieira|first2=Carolina Sales|last3=Ferriani|first3=Rui Alberto|last4=dos Reis|first4=Rosana Maria|last5=Nogueira|first5=Antonio Alberto|last6=Brito|first6=Luiz Gustavo Oliveira|title=Presentation and treatment of uterine leiomyoma in adolescence: a systematic review|journal=BMC Women's Health|volume=15|issue=1|year=2015|issn=1472-6874|doi=10.1186/s12905-015-0162-9}}</ref> Up to 50% of women with uterine fibroids have no symptoms. The prevalence of uterine fibroids among teenagers is 0.4%.<ref name="mor2015"/>

===Europe===
The incidence of uterine fibroids in Europe is thought to be lower than the incidence in the US.<ref name=par2015/>

===United States===
Eighty percent of African-American women will develop benign uterine fibroid tumors by their late 40s, according to the National Institute of Environmental Health Sciences.<ref>{{cite web|title=Helping Black Women Recognize, Treat Fibroids|url=http://www.npr.org/templates/story/story.php?storyId=89344394|work=NPR|accessdate=30 March 2011}}</ref> African-American women are two to three times more likely to get fibroids than Caucasian women.<ref name=par2015/><ref name=MM18>{{MerckManual|18|248|a||Uterine Fibroids}}</ref><ref>{{cite web|title=African American Women and Fibroids|url=http://www.blackwomenshealthproject.org/aafibroids.htm|work=Philadelphia Black Women's Health Project|accessdate=30 March 2011}}</ref> In African-American women fibroids seem to occur at a younger age, grow more quickly, and are more likely to cause symptoms.<ref>{{cite web|title=Minority Women's Health|url=http://www.womenshealth.gov/minority/africanamerican/uterine-fibroids.cfm|publisher=Women's Health.gov}}</ref> This leads to higher rates of surgery for African Americans, both myomectomy, and hysterectomy.<ref name=BWHP10>{{cite news|title=Black Women and High Prevalence of Fibroids|url=http://www.fibroids.com/news-blog/2010/11/black-women-fibroids/|accessdate=30 March 2011|newspaper=Fibroid Treatment Collective|date=November 29, 2010}}</ref> Increased risk of fibroids in African- Americans causes them to fare worse in in-vitro fertility treatments and raises their risk of premature births and delivery by Cesarean section.<ref name=BWHP10/>

It is unclear why fibroids are more common in African American women. Some studies suggest that black women who are obese and who have high blood pressure are more likely to have fibroids.<ref name=BWHP10/> Other suggested causes include the tendency of African American women to consume food with less than the daily requirements for vitamin D.<ref name=par2015/>

==Society and culture==

===United States law===
The 2005 S.1289 bill was read twice and referred to the committee on Health, Labor, and Pensions but never passed for a Senate or House vote. The proposed Uterine Fibroid Research and Education Act of 2005 mentioned that $5 billion is spent annually on hysterectomy surgeries each year, which affect 22% of African Americans and 7% of Caucasian women. The bill also called for more funding for research and educational purposes. It also states that of the $28 billion issued to NIH,<ref>http://officeofbudget.od.nih.gov/pdfs/FY11/Approp.%20History%20by%20IC%20(FINAL).pdf{{full citation needed|date=October 2014}}</ref> $5 million was allocated for uterine fibroids in 2004.

==Other animals==
Uterine fibroids are rare in other mammals, although they have been observed in certain dogs and Baltic [[grey seal]]s.<ref>{{cite journal | vauthors = Bäcklin BM, Eriksson L, Olovsson M | title = Histology of uterine leiomyoma and occurrence in relation to reproductive activity in the Baltic gray seal (Halichoerus grypus) | journal = Vet. Pathol. | volume = 40 | issue = 2 | pages = 175–80 | date = March 2003 | pmid = 12637757 | doi = 10.1354/vp.40-2-175 }}</ref>

==Research==
[[Selective progesterone receptor modulator]]s, such as [[progenta]], have been under investigation. Another selective progesterone receptor modulator [[asoprisnil]] is being tested with promising results as a possible use as a treatment for fibroids, intended to provide the advantages of progesterone antagonists without their adverse effects.<ref name=Sankaran_2008 /> Low dietary intake of [[vitamin D]] is associated with the development of uterine fibroids.<ref name=par2015>{{cite journal|last1=Parazzini|first1=Fabio|last2=Di Martino|first2=Mirella|last3=Candiani|first3=Massimo|last4=Viganò|first4=Paola|title=Dietary Components and Uterine Leiomyomas: A Review of Published Data|journal=Nutrition and Cancer|volume=67|issue=4|year=2015|pages=569–579|issn=0163-5581|doi=10.1080/01635581.2015.1015746}}</ref>
{{trans F}}
== References ==
{{reflist|32em}}

== External links ==
{{Medical resources
| DiseasesDB = 4806
| ICD10 = {{ICD10|D|25||d|10}}
| ICD9 = {{ICD9|218}}
| ICDO =
| OMIM = 150699
| MedlinePlus = 000914
| eMedicineSubj = radio
| eMedicineTopic = 777
| MeshID = D007889
}}
{{Commons category|Uterine fibroids}}
*[http://fibroids.nichd.nih.gov/index.html NIH Fibroid Treatment Study: Information and NIH research]

{{Genital neoplasia}}


{{DEFAULTSORT:Uterine Fibroids}}


{{女性生殖道肿瘤}}
{{女性生殖道肿瘤}}
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[[ar:ورم عضلي أملس رحمي]]
[[ar:ورم عضلي أملس رحمي]]
[[es:Mioma]]
[[es:Mioma]]
[[ru:Миома матки]]
[[ru:Миома матки]][[Category:Gynaecological neoplasia]]
[[Category:Benign neoplasms]]
[[Category:RTT]]
[[Category:Uterine tumour]]

2017年7月28日 (五) 02:38的版本

子宮肌瘤
子宮肌瘤(圖中以數字標示處)
类型uterine benign neoplasm[*]平滑肌瘤[*]疾病
分类和外部资源
醫學專科肿瘤学
ICD-10D25
ICD-9-CM218.9
OMIM150699
DiseasesDB4806
MedlinePlus[1]
eMedicineradio/777
MeSHD007889
[编辑此条目的维基数据]
子宮肌瘤
Uterine fibroids
同义词Uterine leiomyoma, uterine myoma, myoma, fibromyoma, fibroleiomyoma
Uterine fibroids as seen during laparoscopic surgery英语laparoscopic surgery
症状經痛月經出血量大s[1]
併發症不孕[1]
常見始發於Middle and later reproductive years[1]
肇因未知[1]
风险因子家庭病史、肥胖症、攝取紅肉[1]
診斷方法骨盆檢查醫學影像[1]
相似疾病或共病平滑肌肉瘤妊娠卵巢囊腫卵巢癌[2]
治療藥物、手術、uterine artery embolization英语uterine artery embolization[1]
藥物Ibuprofen, paracetamol (acetaminophen), 鐵元素補充英语iron supplementsgonadotropin releasing hormone agonist英语gonadotropin releasing hormone agonist[1]
预后更年期後可改善[1]
盛行率~50% 的50歲前女性[1]
分类和外部资源
醫學專科婦科學
ICD-9-CM218、​218.9
OMIM150699
DiseasesDB4806
MedlinePlus000914
eMedicine405676
[编辑此条目的维基数据]

子宮肌瘤Uterine fibroids或是Uterine Fibroma或是leiomyomata)是發生於子宮平滑肌瘤英语Leiomyoma。若腫瘤生長在肌壁內稱肌壁間肌瘤;向子宮腔內生長稱粘膜下肌瘤,向子宮漿膜表面生長稱漿膜下肌瘤。大多數得到此疾病的婦女沒有症狀,少數婦女會有經痛經血過多的情形。如果子宮肌瘤壓迫到膀胱,則有可能會發生頻尿症;其他症狀還包括性交疼痛下背痛,且病患可能會出現一至多種症狀。有時子宮肌瘤可能會導致不易懷孕,但這不常見[1]

子宮肌瘤的確實發病機制尚不清楚。然而若家族中有子宮肌瘤病史,罹患機率也比較高,部份原因可能和荷爾蒙比例有關。 子宮肌瘤的風險因子包含肥胖症與攝食太多紅肉。檢查可以透過骨盆檢查醫學影像來進行[1]

沒有症狀的子宮肌瘤一般是不需治療的。若有輕微症狀,可以用布洛芬乙醯胺酚治療,若月經過多需補充鐵質。性腺激素釋放素抑制劑英语gonadotropin releasing hormone agonists之類的藥物可能可以使肌瘤縮小,但價格昂貴且有副作用。若有較明顯的症狀,手術切除肌瘤甚至子宮會有幫助。也可以用子宫动脉栓塞术英语Uterine artery embolization[1]或是高強度聚焦技術(也稱為海扶刀,HIFU)[3][4]進行治療。平滑肌肉瘤是肌瘤的癌症,非常少見,也不會由良性的子宮肌瘤轉變為平滑肌肉瘤[1]

約20%至80%的女性在50歲以前得過子宮肌瘤[1]。在2013年估計有1.71億的女性得到子宮肌瘤[5]。一般會在生育年齡的中期或末期出現,在停經後其尺寸會縮小[1]。在美國,子宮肌瘤是子宮切除術的常見原因之一[6]

References

  1. ^ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 1.19 1.20 1.21 Uterine fibroids fact sheet. Office on Women's Health. January 15, 2015 [26 June 2015]. 
  2. ^ Ferri, Fred F. Ferri's differential diagnosis : a practical guide to the differential diagnosis of symptoms, signs, and clinical disorders 2nd ed. Philadelphia, PA: Elsevier/Mosby. 2010: Chapter U. ISBN 0323076998. 
  3. ^ 子宮肌瘤免動刀新療法-海扶刀(HIFU). 高醫院訊. 鄭丞傑. 2015-08 [2016-02-06]. 
  4. ^ 誇大療效 5日收8萬 治癌中心涉掠水. 蘋果日報 (香港). 2011-11-03 [2016-02-06]. 
  5. ^ 5.0 5.1 Global Burden of Disease Study 2013, Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.. Lancet (London, England). 5 June 2015. PMID 26063472. 
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