| Uterine myomas are benign tumors that mostly occur in women of reproductive age. As leiomyomas grows, they may outgrow their blood supply, resulting in various types of degeneration. Red degeneration is one of them. Red degeneration occurs frequently in gestation period and puerperium. Further researches found that some may happen in non-gestation period even after the menopause. Retrospective analysis was done for the 9782 women with uterine myoma in our hospital from Jan. 1999 to Dec. 2005, among which 398 patients occurred the red degeneration. The incidence rate is 4.07%. A total of 236 cases(2.41%) with red degeneration occur in non-gestation and 36 cases(2.41%) happened in peri-menopausal period, while the other 32 patients (13.6%) occurred after menopause. All the cases were confirmed by the pathology. Red degeneration is a special sort of necrosis occurring in myoma. The mechanism is still unknown. It may come after the angio-cataplasis of myoma, as additional embolism and haemolysis make hemoglobin infiltrating into the matrix of myoma. While other hypotheses suggest the red degeneration results from hyaline-degenerating of leiomyoma with hemorrhagic necrosis. On the other hand, most of the non-gestational red degeneration occurs in women of reproductive age. Huge volume, fast growth, bad-blood supply and poor tolerance are the potential factors. Surgery on the pelvis, contraceptive ring or sexual hormone for oral use can also lead to the red degeneration. For women with hypertension and diabetes, theaggravation of capillary vessel may also promote the red degeneration of original leiomyoma. Women has non-specific symptoms with red degeneration of uterine myoma, which may come with complaints of abdominal pain, fever, enlargement of uterine size, tenderness on lower abdomen and increase of leukocyte. With ultrasound examination, the uterus shows the feature of increasing bulk, low echo or uneven echo mass, hypo-or oligo-blood flow. Nevertheless, a part of atypical cases cannot be ignored. For certain diagnosis, punctuation biopsy under ultrasound could be performed. Other detection such as MRI or X-ray layer imaging makes the necessary assist. As for the treatment, surgical measures are commonly used with high utility. Abdominal or vaginal surgery, or measures through the laparoscope and colposcope are often selected, considering the mass size, position, age of patients, reproductive desire and medical condition. All cases were treated with surgical interventions with 100% of cure rate. No complication was observed after surgery. Otherwise conservative treatments such as antibiotic injection are also commonly used. In addition, minidose of heparin can be considered for the patients with gestation. However the therapeutic effect has not yet confirmed. |
