子宫肌瘤必要治疗吗？会影响怀孕吗？
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">门诊经常会碰到<span style="color: black;">有些</span>女性<span style="color: black;">伴侣</span>，有二十几岁的，<span style="color: black;">亦</span>有三十几岁育龄期的，还有绝经以后的，她们在体检时<span style="color: black;">发掘</span>了子宫肌瘤，<span style="color: black;">或</span>是<span style="color: black;">由于</span><span style="color: black;">大姨妈</span><span style="color: black;">错乱</span>，来门诊<span style="color: black;">检测</span>时才<span style="color: black;">发掘</span><span style="color: black;">身患</span>子宫肌瘤。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">还有些女性正在备孕，担心子宫肌瘤会不会影响怀孕，怀孕以后会不会影响<span style="color: black;">孩儿</span>等等……</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">今天，北京和睦家京北妇儿医院妇科<span style="color: black;"><span style="color: black;">专家</span></span>王蕊<span style="color: black;">大夫</span>就来和<span style="color: black;">大众</span>来聊一聊：得了子宫肌瘤怎么办？子宫肌瘤<span style="color: black;">必须</span>治疗吗？</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">认识子宫肌瘤</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">首要</span><span style="color: black;">大众</span><span style="color: black;">不消</span>担心，子宫肌瘤是一种女性<span style="color: black;">平常</span>的良性肿瘤，百分之九十几的子宫肌瘤都是良性的，<span style="color: black;">仅有</span>不到1%的恶变率。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">教科书上写<span style="color: black;">出现</span>子宫肌瘤的比例是30%<span style="color: black;">上下</span>，<span style="color: black;">然则</span>这是不准确的，<span style="color: black;">实质</span>的数值其实比它高。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://q4.itc.cn/q_70/images03/20240417/ec49cee655f74775990aab8d1a743c63.jpeg" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><span style="color: black;">照片</span><span style="color: black;">源自</span>：</span><span style="color: black;">bigstock</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><span style="color: black;"><span style="color: black;">为何</span>说子宫肌瘤比书上说的更常见？</span></span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">由于</span><span style="color: black;">非常多</span>女性在体检的时候，<span style="color: black;">发掘</span>了<span style="color: black;">仅有</span>一公分、两公分的小肌瘤，<span style="color: black;">大姨妈</span><span style="color: black;">亦</span>正常，就不会为此特地来门诊看诊，<span style="color: black;">因此</span>在进行流行病学调查的时候就<span style="color: black;">发掘</span>不了这类人群。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">因此呢</span>，子宫肌瘤<span style="color: black;">实质</span>的<span style="color: black;">出现</span>率可能要高于教科书上所记载的。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">得了子宫肌瘤怎么办？</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">发掘</span>子宫肌瘤，要<span style="color: black;">按照</span><span style="color: black;">病人</span>年龄，<span style="color: black;">是不是</span>有生育<span style="color: black;">需求</span>，<span style="color: black;">大姨妈</span>有<span style="color: black;">无</span>改变，有<span style="color: black;">无</span><span style="color: black;">有些</span>其它<span style="color: black;">反常</span>的影像学的变化来决定<span style="color: black;">必须</span>进行<span style="color: black;">怎么样</span>的治疗。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">子宫肌瘤有<span style="color: black;">那些</span><span style="color: black;">归类</span>？</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">1</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">●</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">子宫浆膜下肌瘤</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">第1</span>类叫浆膜下的子宫肌瘤，简单<span style="color: black;">来讲</span><span style="color: black;">便是</span>它往子宫外长，外凸到腹腔里去了。这类肌瘤<span style="color: black;">通常</span><span style="color: black;">来讲</span>不太影响<span style="color: black;">大姨妈</span>，<span style="color: black;">亦</span>可能不会影响怀孕，<span style="color: black;">一般</span><span style="color: black;">无</span>任何的症状。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">这类肌瘤有时候长得很大，大到十几公分。有些女性是在体检时<span style="color: black;">发掘</span>的，<span style="color: black;">或</span>早上起来躺在床上，<span style="color: black;">没</span>意<span style="color: black;">其中</span>摸到小肚子有一个大包，疑惑这是什么东西，到医院<span style="color: black;">检测</span>才<span style="color: black;">发掘</span>的。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://q7.itc.cn/q_70/images03/20240417/cf331c679fac436daad12d684d77f822.jpeg" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">照片</span><span style="color: black;">源自</span>：</span><span style="color: black;">bigstock</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">这类肌瘤<span style="color: black;">必须</span><span style="color: black;">经过</span>手术进行切除，<span style="color: black;">由于</span>它<span style="color: black;">尤其</span>大，占据了腹腔的位置，可能会<span style="color: black;">导致</span>腹胀、腹痛等症状。<span style="color: black;">另一</span>，有的肌瘤会有蒂，<span style="color: black;">亦</span>会<span style="color: black;">出现</span>蒂扭转，<span style="color: black;">导致</span>急腹症。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">●</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">子宫肌壁间肌瘤</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">第二类肌瘤是长在子宫肌壁间的，<span style="color: black;">能够</span>是往宫腔里长，凸向宫腔，还<span style="color: black;">能够</span>是凸向宫腔外的。肌瘤的<span style="color: black;">体积</span>从不到一公分，到几公分，<span style="color: black;">乃至</span>十几公分都有可能。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">这类肌瘤<span style="color: black;">能够</span>生长在子宫体的任何部位，<span style="color: black;">倘若</span>长在靠近子宫角，就有可能压迫到输卵管，<span style="color: black;">引起</span>输卵管变形、不通或通而不畅，会<span style="color: black;">引起</span><span style="color: black;">不育</span><span style="color: black;">乃至</span>宫外孕。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><span style="color: black;">●</span>凸向宫腔外的<span style="color: black;">状况</span>：</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">倘若</span><span style="color: black;">无</span>特殊不适或<span style="color: black;">大姨妈</span>的改变，肌瘤<span style="color: black;">少于</span>5cm以下时可以不做特殊处理，观察肌瘤的生长<span style="color: black;">就可</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">但<span style="color: black;">倘若</span>肌瘤<span style="color: black;">短期</span>生长较快，或影响了<span style="color: black;">大姨妈</span><span style="color: black;">引起</span><span style="color: black;">大姨妈</span>量<span style="color: black;">太多</span>、经期过长，或肌瘤大于5cm以上，<span style="color: black;">能够</span><span style="color: black;">思虑</span>手术治疗。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><span style="color: black;">● </span>凸向宫腔内的<span style="color: black;">状况</span>：</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">这种类型的子宫肌瘤会<span style="color: black;">导致</span><span style="color: black;">大姨妈</span>的改变，有的人会<span style="color: black;">显现</span><span style="color: black;">大姨妈</span>经期过长，由原来的四五天一下延长到了七八天<span style="color: black;">乃至</span>十几天，<span style="color: black;">或</span><span style="color: black;">大姨妈</span>量<span style="color: black;">尤其</span>大，<span style="color: black;">必须</span>用夜用卫生巾，还有大的血块。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">这种<span style="color: black;">状况</span>下，即使肌瘤很小，<span style="color: black;">亦</span>可能<span style="color: black;">必须</span>进一步的手术治疗，否则容易<span style="color: black;">显现</span>贫血，带来其它<span style="color: black;">反常</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://q1.itc.cn/q_70/images03/20240417/cb4abbcdd30843bdabbbf5ce3876f111.jpeg" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">照片</span><span style="color: black;">源自</span>：</span><span style="color: black;">bigstock</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">这类肌瘤可能<span style="color: black;">导致</span>女性<span style="color: black;">很难</span>怀孕，即使<span style="color: black;">怀孕</span>了<span style="color: black;">亦</span><span style="color: black;">尤其</span>容易流产，<span style="color: black;">由于</span>凸向宫腔的肌瘤改变了宝宝要待的这个“房子”的形状，<span style="color: black;">亦</span>使子宫内膜这个孕育生命的“土壤”<span style="color: black;">出现</span>变化，胚胎<span style="color: black;">不易</span>着床，想要怀孕的女性<span style="color: black;">伴侣</span><span style="color: black;">尤其</span><span style="color: black;">必须</span><span style="color: black;">重视</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">3</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">●</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">子宫粘膜下肌瘤</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">第三类肌瘤是完全长在宫腔里的。<span style="color: black;">咱们</span>宫腔很小，正常<span style="color: black;">状况</span>下只能装5毫升水，当有一个公分的<span style="color: black;">乃至</span>不到一个公分的小肌瘤长在宫腔里的时候，可能都会影响<span style="color: black;">大姨妈</span>，严重的话还会贫血。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">倘若</span><span style="color: black;">经过</span><span style="color: black;">检测</span><span style="color: black;">发掘</span>了这类肌瘤，虽然它可能个头不大，可能<span style="color: black;">亦</span>要<span style="color: black;">经过</span>手术治疗。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">4</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">●</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">特殊部位的子宫肌瘤</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">还有一类<span style="color: black;">便是</span>特殊部位的子宫肌瘤，<span style="color: black;">例如</span>宫颈肌瘤、阔韧带肌瘤等，会带来<span style="color: black;">有些</span>相应的症状，可能<span style="color: black;">亦</span><span style="color: black;">必须</span>手术治疗。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">子宫肌瘤的治疗</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">有些女性<span style="color: black;">伴侣</span><span style="color: black;">尤其</span>恐惧做手术，虽然<span style="color: black;">大姨妈</span>量、<span style="color: black;">大姨妈</span>经期都受到了影响，<span style="color: black;">乃至</span><span style="color: black;">显现</span>了贫血症状，但<span style="color: black;">便是</span>不想接受手术治疗，怎么办呢？</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">对手术有抵触<span style="color: black;">心情</span>的<span style="color: black;">病人</span>，<span style="color: black;">亦</span><span style="color: black;">能够</span>采取<span style="color: black;">药品</span>保守治疗。</span><span style="color: black;"><span style="color: black;">然则</span>在决定治疗方式之前<span style="color: black;">亦</span>要有心理准备，<span style="color: black;">由于</span><span style="color: black;">药品</span>治疗有失败的可能性，<span style="color: black;">倘若</span>保守治疗的效果<span style="color: black;">欠好</span>，可能还是要做手术的。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">必须</span><span style="color: black;">尤其</span>强调的是，<span style="color: black;">针对</span><span style="color: black;"><span style="color: black;">有生育<span style="color: black;">需求</span>的女性</span></span>，要<span style="color: black;">按照</span>年龄，肌瘤的<span style="color: black;">体积</span>，生长的部位等<span style="color: black;">原因</span>来决定采取什么样的治疗<span style="color: black;">办法</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://q1.itc.cn/q_70/images03/20240417/96956e7aacde425dade3ac3e6cb7efa5.jpeg" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><span style="color: black;">照片</span><span style="color: black;">源自</span>：</span><span style="color: black;">bigstock</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">由于</span>手术治疗会<span style="color: black;">引起</span>子宫的瘢痕形成，<span style="color: black;">倘若</span>是向外凸生长的肌瘤手术，瘢痕的深度小于子宫肌壁的1/3，术后半年<span style="color: black;">能够</span><span style="color: black;">思虑</span>妊娠；但<span style="color: black;">倘若</span>肌瘤位置较深，瘢痕对下一次妊娠的影响<span style="color: black;">很强</span>，则可能要1.5-2年才<span style="color: black;">能够</span>怀孕。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">子宫肌瘤的手术<span style="color: black;">按照</span>肌瘤的<span style="color: black;">体积</span>、位置、个数，<span style="color: black;">病人</span>年龄、生育<span style="color: black;">状况</span>以及术者的手术技能等，<span style="color: black;">能够</span>采取开腹手术、经阴道手术、腹腔镜手术、达芬奇<span style="color: black;">设备</span>人手术等。<span style="color: black;">能够</span><span style="color: black;">剔除</span>肌瘤<span style="color: black;">保存</span>子宫，<span style="color: black;">亦</span><span style="color: black;">能够</span>采取子宫切除的方式。</span></p>
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<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">专家</span>医师、<span style="color: black;">教授</span></p>
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<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">◆ </span><span style="color: black;">王蕊<span style="color: black;">大夫</span>1987年大学毕业，1993年<span style="color: black;">得到</span>妇产科硕士学位，2005年<span style="color: black;">得到</span>北京大学医学部妇产科博士学位。2000年在北京大学第三医院生殖医学中心进修学习。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">◆</span>在加入和睦家京北妇儿医院之前，王<span style="color: black;">大夫</span>在白求恩医科大学<span style="color: black;">附庸</span>第二临床学院妇产科、首都医科大学<span style="color: black;">附庸</span>北京天坛医院妇产科工作。担任首都医科大学妇产科学系教授、硕士<span style="color: black;">科研</span>生导师。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">◆</span>王<span style="color: black;">大夫</span><span style="color: black;">持有</span>三十<span style="color: black;">数年</span>的临床实践经验。<span style="color: black;">针对</span>子宫肌瘤、卵巢囊肿、子宫内膜异位症、<span style="color: black;">不育</span><span style="color: black;">不孕</span>、<span style="color: black;">大姨妈</span><span style="color: black;">反常</span>、卵巢早衰、多囊卵巢综合症、尿失禁等<span style="color: black;">疾患</span>的诊治有丰富的经验。<span style="color: black;">善于</span>子宫肌瘤、卵巢肿瘤、子宫内膜异位症、宫腔粘连、输卵管<span style="color: black;">不育</span>、子宫畸形、尿失禁、器官脱垂、宫颈<span style="color: black;">疾患</span>、女性私密整形的微创外科手术。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">◆</span>王<span style="color: black;">大夫</span>曾主持并参与国家科技攀登计划、卫生部、北京市卫计委、首都医科大学、吴阶平医学基金会、中国-欧盟第七框架合作课题等多项<span style="color: black;">研究</span>课题。并<span style="color: black;">得到</span>过《全国妇幼健康科学技术奖·自然科学》二等奖。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">◆</span>王<span style="color: black;">大夫</span>是中国老年保健协会中老年性与生殖健康专业委员会副<span style="color: black;">专家</span>委员、北京医学会妇科微创专业委员会委员、中国整形美容协会女性生殖整复分会理事、中国整形美容协会科技创新与器官整复分会理事、北京医师协会妇产科分会理事等多个学术组织内任职。</span><a style="color: black;"><span style="color: black;">返回<span style="color: black;">外链论坛：www.fok120.com</span>，查看<span style="color: black;">更加多</span></span></a></p>
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系统提示我验证码错误1500次 ＼~゛， “板凳”（第三个回帖的人） 你的留言真是温暖如春，让我感受到了无尽的支持与鼓励。 你的话语如春风拂面，让我感到无比温暖。 感谢您的精彩评论，为我带来了新的思考角度。
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