RESUMO
The introduction of conservative management options has further increased the choices available to clinicians treating women with symptomatic uterine fibroids. However, in the absence of a tissue diagnosis, the possibility of mismanaging an underlying uterine sarcoma is still present, placing these patients at potential risk of a delayed diagnosis of this serious pathology. Evidence suggests that 1 in 250-400 women presenting with what are thought to be symptomatic fibroids, will in fact have an underlying sarcoma, making this an important clinical issue. This paper therefore reviews the methods currently available for the assessment of women in whom conservative management of symptomatic fibroids is contemplated.
Assuntos
Leiomioma/diagnóstico , Sarcoma/diagnóstico , Neoplasias Uterinas/diagnóstico , Adulto , Angiografia , Biópsia por Agulha , Diagnóstico Diferencial , Feminino , Hormônio Liberador de Gonadotropina/administração & dosagem , Humanos , Leiomioma/tratamento farmacológico , Leiomioma/patologia , Imageamento por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Medição de Risco , Sarcoma/patologia , Sarcoma/terapia , Ultrassonografia/métodos , Neoplasias Uterinas/tratamento farmacológico , Neoplasias Uterinas/patologiaRESUMO
Traditional operative treatments for symptomatic fibroids--hysterectomy and myomectomy--involve considerable morbidity. Although morbidity is reduced with endoscopic surgery, this technique is not widely available, and has limitations. Embolisation of the pelvic vasculature is not a new procedure, having been used to treat postpartum and postsurgical bleeding for 20 years. It has only recently been used to treat symptomatic fibroids. Uterine artery embolisation can produce a mean reduction of 29%-51% in uterine volume at the time of the three-month review, with longer follow-up showing continued shrinkage and no regrowth. The range of shrinkage is highly variable, which needs to be explained to all potential candidates. Symptomatic relief is a more certain outcome, with relief of pelvic pressure symptoms in 91%-96% of women. There is a small risk of complications requiring hysterectomy, and the long-term effect on ovarian function is unknown.
Assuntos
Embolização Terapêutica/métodos , Leiomioma/terapia , Radiografia Intervencionista/métodos , Neoplasias Uterinas/terapia , Útero/irrigação sanguínea , Artérias , Embolização Terapêutica/efeitos adversos , Feminino , Fluoroscopia/métodos , Humanos , Histerectomia , Leiomioma/diagnóstico , Ovário/fisiologia , Seleção de Pacientes , Radiografia Intervencionista/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Neoplasias Uterinas/diagnóstico , Útero/patologiaRESUMO
The decision to perform bilateral oophorectomy at the time of surgery for endometriosis is dependent upon many factors, one of which is the opinion of the surgeon concerned. At present there is no consensus on this subject, and in an attempt to document current opinion, we performed a postal survey of all Fellows of RANZCOG living within Australia. The questionnaire presented the Fellow with a clinical scenario describing moderate endometriosis, and then asked him/her to select their preferred option for each of a number of anatomical areas. Out of 1,050 questionnaires, 688 (65.5%) were returned. Analysis of these replies suggests that current opinion supports a conservative approach to surgery, with only 27.5% of Fellows electing to perform a hysterectomy in conjunction with bilateral oophorectomy.
