На настоящий момент не определено, какое лечение является лучшим лечением мимомы

[Dr. Nika]

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No Definitive Best Treatment Approaches Found for Uterine Fibroids

Study Highlights
MEDLINE, the Cochrane Collaboration, and EMBASE databases were searched for English-language studies from 2000 to 2006, and 107 were identified.
Studies with sample size of less than 100 for case series and less than 40 for cohort studies or those deemed not relevant were excluded.
2 studies reported incidence and prevalence.
In an urban population of whites and blacks, using ultrasound confirmation, the incidence was nearly 70% by age 50 years for white women and greater than 80% for black women.
An incidence of 2.97 per 100 person-years was reported for blacks in a nationwide sample.
Treatments and outcomes:

There was no literature reporting the natural history of fibroid incidence, growth, symptoms, or outcomes when women chose watchful waiting over intervention.
8 of 13 studies on GnRH agonists provided moderate evidence for effectiveness in decreasing fibroid size when used preoperatively or as an alternative to surgery, and 3 studies provided weak evidence of symptom relief.
1 study provided weak evidence for reduction in uterine size by lynestrenol, a progestin.
1 study provided weak evidence for mifepristone for fibroid size reduction and blood loss.
3 studies provided weak evidence for the role of estrogen receptor modulators and antagonists for fibroid reduction and endometrial growth.
UAE was examined in 23 studies, with moderate evidence for reduced operative times and shorter hospital stays but not longer term outcomes compared with myomectomy or hysterectomy.
Largest case series reported a hospital complication rate of 2.7% (0.6% major) and postdischarge complication rate of 26.2% (4.1% major).
Higher rate of subsequent intervention was reported after UAE vs myomectomy (29 vs 3% at 3 - 5 years).
3 studies on endometrial ablation were of poor quality.
Evidence for magnetic resonance imaging–guided focused ultrasound ablation was weak, with modest change in fibroid size (13% reduction) and improvement in quality of life (71%) reported, and 28% elected other subsequent treatment including myomectomy and hysterectomy in 1 study.
Overall evidence on abdominal, laparoscopic, and hysteroscopic myomectomy was weak.
For abdominal myomectomy, transfusion risk was estimated at 5% to 21%, 3% to 4% required intraoperative conversion to hysterectomy, and wound healing affected 2% to 4%.
Fibroid recurrence affected 18% to 62% of women 3 to 4 years after surgery.
For laparoscopic myomectomy, transfusion was from 1% to 8%, conversion to open procedures occurred in 9%, and fibroid recurrence occurred in 13% to 27%, with 7% to 12% having additional surgery after a few years.
For hysteroscopic myomectomy, risk for perforations was 1 in 100, repeat procedures affected 2% to 20%, and more than 80% reported good outcomes for symptoms.
Most hysterectomy studies reported only short-term outcomes with shorter hospital stays for vaginal vs abdominal procedures.
Laparoscopically assisted vaginal hysterectomy was associated with shorter hospital stay, convalescence, and use of analgesia, but longer outcomes were not reported.
Weak evidence was available for 1 study for traditional Chinese medicine over standard medical treatment.
Surgical vs no intervention for women seeking fertility treatment was associated with 15% increase in women becoming pregnant.
There was no evidence for the role of treatment for asymptomatic women.
Menopausal treatment had no effect on fibroid size.
A history of prior procedures increased risk for adverse outcomes.