长了子宫肌瘤怎么办？

        子宫肌瘤是女性生殖器官中最常见的一种良性肿瘤，也是人体中最常见的肿瘤之一。由于子宫肌瘤主要是由子宫平滑肌细胞增生而成，其中有少量纤维结缔组织作为一种支持组织而存在，故称为子宫平滑肌瘤，简称子宫肌瘤。

       多数患者无症状，仅在盆腔检查或超声检查时偶被发现。黏膜下肌瘤者子宫肌壁间肌瘤图像粘膜下时常可引起不规则阴道流血或月经过多。常见的症状有以下几个方面：

（1）子宫出血 为子宫肌瘤最主要的症状，出现于半数以上的患者。表现为月经量增多、经期延长或周期缩短。亦可表现为不具有月经周期性的不规则阴道流血。

（2）腹部包块及压迫症状 肌瘤可导致子宫增大，当子宫超过怀孕3个月子宫大小或为位于宫底部的较大下肌瘤时，常能在腹部触及包块，膀胱充盈时更为明显。肌瘤长到一定大小时可引起周围器官压迫症状，子宫前壁肌瘤贴近膀胱者可产生尿频、尿急；巨大宫颈肌瘤压迫膀胱可引起排尿不畅甚至尿潴留；子宫后壁肌瘤特别是峡部或宫颈后唇肌瘤可压迫直肠，引起大便不畅、排便后不适感；巨大阔韧带肌瘤可压迫输尿管，甚至引起肾盂积水。

（3）疼痛 一般情况下子宫肌瘤不引起疼痛，但不少患者可诉有下腹坠胀感、腰背酸痛。当浆膜下肌瘤发生蒂扭转或子宫肌瘤发生红色变性时可产生急性腹痛。

（4）白带增多 子宫腔增大，子宫内膜腺体增多，加之盆腔充血，可使白带增加。子宫或宫颈的黏膜下肌瘤发生溃疡、感染、坏死时，则产生血性或脓性白带。

（5）不孕与流产 有些子宫肌瘤患者伴不孕或易发生流产，对受孕及妊娠结局的影响可能与肌瘤的生长部位、大小及数目有关。巨大子宫肌瘤可引起宫腔变形，妨碍孕囊着床及胚胎生长发育；肌瘤压迫输卵管可导致管腔不通畅；黏膜下肌瘤可阻碍孕囊着床或影响精子进入宫腔。

（6）贫血 由于长期月经过多或不规则阴道流血可引起失血性贫血，较严重的贫血多见于黏膜下肌瘤患者。严重贫血可引起脑缺氧甚至脑梗塞。

（7）其他 极少数子宫肌瘤患者可产生红细胞增多症，低血糖，一般认为与肿瘤产生异位激素有关。

        如肌瘤较小，无明显症状，且无恶变征象，可定期随诊观察。

        子宫肌瘤出现以下情况需要手术治疗：

（1）子宫肌瘤合并月经过多或异常出血甚至导致贫血，或出现压迫症状。

（2） 因肌瘤造成不孕或反复流产。

（3） 准备怀孕时若肌瘤直径4厘米可以考虑剔除。

（4）绝经后肌瘤仍生长。

（5）有蒂肌瘤扭转引起的急性腹痛。

（6）粘膜下肌瘤。

（7）肌瘤短期内生长迅速，且影像学检查提示有变性可能。

子宫肌瘤可以选择哪种手术方式和方案？

可选择腔镜（包括单孔/多孔腹腔镜、v-notes）、开腹、宫腔镜、经阴道手术。

子宫肌瘤主要手术方案包括：

（1）保留子宫的肌瘤切除术 将子宫肌瘤摘除而保留子宫的手术。主要用于40岁以下年轻妇女，希望保留生育功能者。近年来由于生活水平提高很多妇女希望保留子宫，有的子宫肌瘤数量很多、或肌瘤很大，但只要还没有绝经都可以考虑保留子宫，剔除肌瘤。

        上海市东方医院李芳主任团队，对保留子宫的肌瘤剔除手术具有丰富的临床经验。

        曾经有位患者因害怕手术，子宫肌瘤长至肋骨下，患者强烈要求保留子宫，李芳主任团队剔除33枚肌瘤，帮患者保住了子宫。患者术后恢复良好，非常感谢李芳主任团队。

        另一位患者巨大粘膜下肌瘤，多处就诊医生均建议其行子宫切除手术，慕名找到李芳主任团队，为其进行了保留子宫的肌瘤摘除手术，患者本人和家属异常感动。很多子宫肌瘤患者，李芳主任团队为其保留了子宫。

（2）子宫切除术 症状明显者，肌瘤有恶性变可能者，或肌瘤交大无生育要求，也可行子宫切除术。

李芳主任临床团队

        上海市东方医院（同济大学附属东方医院）本部妇科设有普通妇科、宫颈疾病、妇科肿瘤、盆底重建、生殖外科、计划生育和妇科内镜。妇科以“创建诊疗特色鲜明的临床研究复合型学科”为目标，在医、教、研各方面实现跨越式发展，各亚专科逐渐形成明显特色。科室始终坚持以人为本，重点培养中青年技术骨干，增强团队的整体技术能力，优化医疗环境，提高医疗质量。开展新技术、新项目，倡导微笑服务，不断焕发新的活力，在竞争中发展壮大。

        科室技术力量雄厚，病房4K腹腔镜、3D腹腔镜等国际一流的现代化新型手术设备，能完成各类妇科手术诊治，在妇科良、恶性肿瘤诊断、手术和综合治疗方面积累了丰富的临床经验。在妇科微创手术、腹腔镜/单孔腹腔镜、妇科盆底重建、妇科肿瘤保留子宫和生育功能的手术等方面具有鲜明特色。宫颈癌前病变及宫颈癌诊疗水平居国际领先地位。

        目前妇科门诊：开设了宫颈疾病、普通妇科门诊、宫腔镜门诊，计划生育门诊，妇科肿瘤门诊。门诊开展阴道镜以及显微阴道镜检查，leep术，宫腔镜检查，无痛人流以及各类计划生育手术。

专家门诊时间：

周一全天、周二上午

周四下午妇科专家特需门诊

地址：上海市浦东新区即墨路150号，上海市东方医院总院。

周二下午妇科专家门诊，

地址：上海市浦东新区云台路1800号，上海市东方医院 南院

周四上午线上门诊。

李芳主任临床科研团队

        李芳主任团队开展临床和临床相关基础研究。

        同济大学附属东方医院本部妇科是妇科学博士后和硕博士研究生培养点，医师规范化培训基地。主要研究方向：高危HPV整合相关致癌机制、三代转录组和宫单细胞测序揭示宫颈癌免疫微环境和宫颈癌免疫治疗新靶点。李芳教授以通讯作者身份在Nucleic Acids Research, J Exp Clin Cancer Res.等期刊上发表40余篇学术论文。累计影响因子251.4分，最高影响因子20.69分。主持国家自然基金、科技部重大项目、上海市科委、卫健委和上海市申康课题20余项。主编论著2部。获省部二等奖1项（2/7）。国家级 宫颈病专业精英奖 1项。获批准发明专利3项，实用新型专利5项。知识产权转化1项：显微内镜在体病理诊断子宫颈病变。实验室依托同济大学附属东方医院转化医学研究中心，拥有具有完成国家级科研项目所必需的先进仪器设备和充足的科研经费。

发表论文目录如下：

1. Min Liu＃, Zhiqiang Han＃, Yong Zhi, Yetian Ruan, Guangxu Cao, Guangxue Wang, Xinxin Xu, Jianbing Mu, Jiuhong Kang, Fangping Dai, Xuejun Wen, Qingfeng Zhang*, Fang Li*. Long-read sequencing reveals oncogenic mechanism of HPV-human fusion transcripts in cervical cancer. Translational Research. (IF=10.17)

2. Zhi Y, Chen X, Cao G, Chen F, Seo HS, Li F. The effects of air pollutants exposure on the transmission and severity of invasive infection caused by an opportunistic pathogen Streptococcus pyogenes. Environ Pollut. 2022 Oct 1;310:119826. IF=9.98

3. Hu H, Yang M, Dong W, Yin B, Ding J, Huang B, Zheng Q, Li F, Han L. A Pyroptosis-Related Gene Panel for Predicting the Prognosis and Immune Microenvironment of Cervical Cancer. Front Oncol. 2022 Apr 29;12:873725. IF=5.7

4. Jianyi D, Haili G, Bo Y, Meiqin Y, Baoyou H, Haoran H, Fang L, Qingliang Z, Lingfei H. Myeloid-derived suppressor cells cross-talk with B10 cells by BAFF/BAFF-R pathway to promote immunosuppression in cervical cancer. Cancer Immunol Immunother. 2022 Jun 20. IF=6.3

5. Yang, M.＃, Hu, H.＃, Wu, S., Ding, J., Yin, B., Huang, B., Li, F.*, Guo, X.*, ＆ Han, L*. (2022). EIF4A3-regulated circ_0087429 can reverse EMT and inhibit the progression of cervical cancer via miR-5003-3p-dependent upregulation of OGN expression. Journal of experimental ＆ clinical cancer research : CR, 41(1), 165. IF=12.66

6. Yin Bo＃, Ding Jianyi＃, Hu Haoran＃, Yang Meiqin, Huang Baoyou, Dong Wei*, Li Fang*, Han Lingfei*. Overexpressed CMTM6 improves prognosis and associated with immune infiltrates of ovarian cancer. Front Mol Biosci.2021. IF=6.11

7. Le Fu＃, Wei Xia＃, Wei Shi, Guangxu Cao, Yetian Ruana, Xingyu Zhao, Min Liu, Sumei Niu, Fang Li*, Xin Gao*. Deep learning based cervical screening by the cross-modal integration of colposcopy, cytology, and HPV test. International Journal of Medical Informatics,159 (2022) 104675. IF=4.73

8. Xinxin Xu＃, Zhiqiang Han＃, Yetian Ruan, Min Liu, Guangxu Cao, Chao Li*, Fang Li*. HPV16-LINC00393 integration alters local 3D genome architecture in cervical cancer cells. Front Cell Infect Microbiol. 2021 Dec 7;11:785169. IF=6.07

9. Zhiyuan Huang＃, Fang Li*, Qinchuan Li*. Expression profile of RNA binding protein in cervical cancer using bioinformatics approach. Cancer Cell Int. 2021 Dec 4;21(1):647. IF=6.42

10. Li Y＃, Gong YX＃, Wang Q, Gao S, Zhang H, Xie F, Cong Q, Chen L, Zhou Q, Hong Z, Qiu L, Li F, Xie Y*, Sui L*. Optimizing the Detection of Occult Cervical Cancer: A Prospective Multicentre Study in China. Int J Womens Health. 2021 Oct 27;13:1005-1015. IF=2.59

11. Zhu J＃, Chen F, Luo L, Wu W, Dai J, Zhong J, Lin X, Chai C, Ding P, Liang L, Wang S, Ding X, Chen Y, Wang H, Qiu J, Wang F, Sun C, Zeng Y, Fang J, Jiang X, Liu P, Tang G, Qiu X, Zhang X, Ruan Y, Jiang S, Li J, Zhu S, Xu X, Li F, Liu Z, Cao G*, Chen D*. Single-cell atlas of domestic pig cerebral cortex and hypothalamus. Science Bulletin 2021, 66(14): 1448-1461. IF=20.57

12. Ruan Y＃, Liu M, Guo J, Zhao J, Niu S, Li Fang*, Evaluation of the accuracy of colposcopy in detecting high-grade squamous intraepithelial lesion and cervical cancer. Arch Gynecol Obstet. 2020 Aug;10.1007/s00404-020-05740-x. doi:10.1007/s00404-020-05740-x IF=2.49

13. Guo, Junhan＃, Fu Le＃, Zhao Junwei, Lei Lei, Zhan Qin, Liu Min, Ruan Yetian, Li Hui, Xu Jin, Li Nana, Wang Hanlin, Zhu Huiting, Han Zhiqiang, Li Fang*, The value of microendoscopy in the diagnosis of cervical precancerous lesions and cervical microinvasive carcinoma. Archives of Gynecology and Obstetrics. 2020 June 302. doi:10.1007/s00404-020-05565-8. IF=2.49

14. Wen Yu＃, Cai Long, Tailin Zhu, Huiting Zhu, Zhiqiang Han*, Fang Li*, High resolution multispectral endoscopy significantly improves the diagnostic accuracy of cervical intraepithelial lesions. Journal of obstetrics and gynaecology research, 2020 April, 46: 939-944. doi:10.1111/jog.14241. IF=1.69

15. Chao Li＃*, Hongfeng Ao＃, Guofang Chen, Fang Wang, Fang Li*. The Interaction of CDH20 With β-Catenin Inhibits Cervical Cancer Cell Migration and Invasion via TGF-β/Smad/SNAIL Mediated EMT. Front Oncol. 2020 Jan 9;9:1481. doi: 10.3389/fonc.2019.01481. IF=5.7

16. Junwei Zhao＃, Qin Zhan, Junhan Guo, Min Liu, Yetian Ruan, Tailin Zhu, Lingfei Han*, Fang Li*. Phylogeny and polymorphism in the E6 and E7 of human papillomavirus: alpha-9 (HPV16, 31, 33, 52, 58), alpha-5 (HPV51), alpha-6 (HPV53, 66), alpha-7 (HPV18, 39, 59, 68) and alpha-10 (HPV6, 44) in women from Shanghai. Infect Agent Cancer. 2019 Nov 21;14:38. doi: 10.1186/s13027-019-0250-9. IF=3.69

17. Junwei Zhao＃, Jiacheng Zhu, Junhan Guo, Tailin Zhu, Jixing Zhong, Min Liu, Yetian Ruan, Shujie Liao*, Fang Li*. Genetic variability and functional implication of HPV16 from cervical intraepithelial neoplasia in Shanghai women. J Med Virol. 2020 Mar;92(3):372-381. doi: 10.1002/jmv.25618. IF=20.69

18. Chao Li＃*, Yanfei Li＃, Lanxia Sui, Jian Wang, Fang Li*, Phenyllactic acid promotes cell migration and invasion in cervical cancer via IKK/NF-κB-mediated MMP-9 activation. Cancer Cell Int. 2019 Sep 23;19:241. doi: 10.1186/s12935-019-0965-0. IF=6.42

19. Huiyan Hu＃, Jingjing Zhao＃, Wen Yu, Junwei Zhao, Zhewei Wang, Lin Jin, Yunyun Yu, Lingfei Han, Lu Wang, Huiting Zhu*, Fang Li*, Human papillomavirus DNA, HPV L1 capsid protein and p16INK4a protein as markers to predict cervical lesion progression. Archives of Gynecology and Obstetrics. 2019 Jan, 299(1):141-149. IF=2.49

20. Junwei Zhao＃, Lu Wang＃, Hui Lin, Wen Yu, Xianghong Xu, Huiyan Hu, Laifang Zhu, Lingfei Han*, Fang Li*, Association of HLA-DRB1/DQB1 polymorphism with high-risk HPV infection and cervical intraepithelial neoplasia women from Shanghai. International Journal of Clinical and Experimental Pathology, 2018.2.15, 11(2):748-756.

21. Yahui Zhang＃, Lin Wang＃, Xiang Xu＃, Fang Li*, Qingsheng Wu*, Combined systems of different antibiotics with nano-CuO against Escherichia coli and the mechanisms involved. Nanomedicine (Lond), 2018 Feb; 13(3):339-351. IF=6.09

22. Xiaojie Huang＃, Chao Li＃, Fang Li, Junwei Zhao, Xiaoping Wan*, Kai Wang*, Cervicovaginal microbiota composition correlates with the acquisition of high- risk human papillomavirus types. International Journal of Cancer, 2018 Aug 1, 143(3):621-634. IF=7.31

23. Dongsheng Chen＃*, Sanjie Jiang, Xiaoyan Ma, Fang Li*, TFBSbank: a platform to dissect the big data of protein-DNA interaction in human and model species. Nucleic Acids Research, 2017.1.4, 45(D1): D151-D157. IF=19.6

24. Xiaohui Zhou＃*, Yanfeng Shi, Lijie Wang, Mei Liu, Fang Li*, Distribution Characteristics of Human Papillomavirus Infection: A Study Based on Data from Physical Examination. Asian Pacific Journal of Cancer Prevention, 2017 Jul 27, 18(7):1875-1879.

25. Junwei Zhao＃, Fang Fang＃, Yi Guo, Tailin Zhu, Yunyun Yu, Fanfei Kong, Lingfei Han, Dongsheng Chen*, Fang Li*, HPV16 integration probably contributes to cervical oncogenesis through interrupting tumor suppressor genes and inducing chromosome instability. Journal of Experimental ＆ Clinical Cancer Research, 2016.11.25, 35(1): 180-180. IF=12.66

26. Yunyun Yu＃, Lingfei Han＃, Wen Yu, Yankang Duan, Zhewei Wang, Huiyan Hu, Junwei Zhao, Suman Singh, Fanfei Kong, Lin Jin, Jing Sun*, Fang Li*, High risk factors associated with HPV persistence after loop electrosurgical excision procedure in patients with intraepithelial neoplasia. International Journal of Clinical and Experimental Pathology, 2017,10(2):1817-1824.

27. Yi Guo＃, Jiachang Hu, Liping Zhu, Jing Sun, Longxu Xie, Fanfei Kong, Lingfei Han, Fang Li*, Physical Status and Variant Analysis of Human Papillomavirus 16 in Women from Shanghai. Gynecologic and Obstetric Investigation, 2016.01.01, 81(1):61-70. IF=2.72

28. Suman Singh＃, Qian Zhou＃, Yunyun Yu, Xianghong Xu, Xiaojie Huang, Junwei Zhao, Lingfei Han, Kai Wang, Jing Sun*, Fang Li*, Distribution of HPV genotypes in Shanghai women. International Journal of Clinical and Experimental Pathology, 2015.01.01, 8(9): 11901-11908.

29. Lingfei Han＃*, Wei Wang＃, Jiahong Lu＃, Fanfei Kong, Ge Ma, Yiping Zhu, Dong Zhao, Jianlong Zhu, Wen Shuai, Qian Zhou, Ping Chen, Lei Ye, Jie Tao, Sarfraz Ahmad, Fang Li*, Jing Sun*, AAV-sBTLA facilitates HSP70 vaccine-triggered prophylactic antitumor immunity against a murine melanoma pulmonary metastasis model in vivo. Cancer Letters, 2014.11.28, 354(2):398-406. IF=9.75

30. Fang Li＃*, Yi Guo, Lingfei Han*, Yankang Duan, Fang Fang, Sumei Niu, Qiujie Ba, Huaishi Zhu, Fanfei Kong, Chao Lin, Xuejun Wen, In vitro and in vivo growth inhibition of drug-resistant ovarian carcinoma cells using a combination of cisplatin and a TRAIL-encoding retrovirus. Oncology Letters, 2012.12.01, 4(6): 1254-1258. IF=3.11

31. Fang Li＃*, Qiujie Ba＃, Sumei Niu, Yi Guo, Yankang Duan, Peng Zhao, Chao Lin*, Jing Sun*, In-situ forming biodegradable glycol chitosan-based hydrogels: Synthesis, characterization, and chondrocyte culture. Materials Science and Engineering: C, 2012.10.1, 32(7): 2017-2025. IF=8.45

32. Fang Li＃*, Jing Sun, Huaishi Zhu, Xuejun Wen, Chao Lin, Donglu Shi, Preparation and characterization novel polymer-coated magnetic nanoparticles as carriers for doxorubicin. Colloids and Surfaces B: Biointerfaces, 2011.11.1, 88(1): 58-62. IF=5.99

33. Xu Song＃*, Fang Li＃, Jingwei Ma, Nengqin Jia*, Jianming Xu, Hebai Shen*, Synthesis of fluorescent silica nanoparticles and their applications as fluorescence probes. Journal of Fluorescence, 2011.5.01, 21(3):1205-1212. IF=2.52

34. Fang Li＃*, Sumei Niu, Jing Sun, Huaishi Zhu, Qiujie Ba, Yi Guo, Donglu Shi, Efficient In Vitro TRAIL-Gene Delivery in Drug-Resistant A2780/DDP Ovarian Cancer Cell Line via Magnetofection. Journal of Nanomaterials, 2011.01.01. IF=3.79

35. Fang Li＃*, Pingping Su＃, Chao Lin, Hong Li, Jiajing Cheng, Donglu Shi, Ribosome display and selection of human anti-placental growth factor scFv derived from ovarian cancer patients. Protein and Peptide Letters, 2010.5.01, 17(5):585-590. IF=1.92

36. Lin, Chao＃*, Peng Zhao＃, Fang Li*, Fangfang Guo, Zhuoquan Li, Xuejun Wen, Thermosensitive in situ-forming dextran-pluronic hydrogels through Michael addition. Materials Science and Engineering: C, 2010.01.01, 30(8):1236-1244. IF=8.45

37. Fang Li＃*, Jianing Li, Xuejun Wen*, Shenghu Zhou, Xiaowen Tong, Pingping Su, Hong Li, Donglu Shi*, Anti-tumor activity of paclitaxel-loaded chitosan nanoparticles: An in vitro study. Materials Science and Engineering: C, 2009.01.01, 29(8):2392-2397. IF=8.45

38. Fang Li＃, Li Meng＃, Hui Xing, Jianfeng Zhou, Shixuan Wang, Lei Huang, Gang Xu, Huaishi Zhu, Yunping Lu, Ding Ma*, Essential role of c-Jun-NH2-terminal kinase on synergy induction of apoptosis by TRAIL plus ADM in ADM resistant MCF-7/ADM cells. Apoptosis, 2006.01.01, 11:1239-1246. IF=5.99

39. Fang Li＃, Li Meng＃, Jianfeng Zhou, Hui Xing, Shixuan Wang, Gang Xu, Huaishi Zhu,Beibei Wang, Gang Chen, Yunping Lu, Ding Ma*, Reversing chemoresistance in cisplatin-resistant human ovarian cancer cells: A role of c-Jun NH(2)-terminal kinase 1. Biochemical and Biophysical Research Communications, 2005.10.01, 335(4):1070-1077. IF=3.32

40. Lei Huang＃, Qilin Ao, Qinghua Zhang, Xiaokui Yang, Hui Xing, Fang Li, Gang Chen, Jianfeng Zhou, Shixuan Wang, Gang Xu, Li Meng, YunPing Lu, Ding Ma*, Hypoxia induced paclitaxel resistance in human ovarian cancers via hypoxia-inducible factor 1 alpha. Journal of Cancer Research and Clinical Oncology, 2010.3.01, 136(3):447-456. IF=4.32

41. 胡家昌(＃)，李芳，高危型HPV DNA与宿主基因整合及致癌机理的相关研究进展，现代妇产科进展，2015.5.01，（05）：384~386

42. 方芳，李芳，段燕康，宫颈病变患者人乳头瘤病毒感染分型研究，中国药房，2013.01.01，（34）：3241~3243

43. 韩凌斐，郭晓青，胡家昌，孔繁飞，何拉曼，李芳，朱建龙，孙静，宫颈癌患者外周血髓源性抑制细胞的比例及其临床意义，华中科技大学学报(医学版)，2015.01.01，（01）：32~36。

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