剖宫产术中经子宫内膜行肌壁间子宫肌瘤剔除术一例

doi:10.3877/cma.j.issn.2095-3259.2022.04.012

中华产科急救电子杂志 ›› 2022, Vol. 11 ›› Issue (04) : 250 -252. doi: 10.3877/cma.j.issn.2095-3259.2022.04.012

病例报告

剖宫产术中经子宫内膜行肌壁间子宫肌瘤剔除术一例

梁祝¹, 贺芳¹^,^†(

)

^1. 广州医科大学附属第三医院妇产科　广东省产科重大疾病重点实验室　广州重症孕产妇救治中心　510150

收稿日期:2022-03-07 出版日期:2022-11-18
通信作者: 贺芳
基金资助:
广州市校联合资助（高水平大学）基础研究项目(202102010131)

Transendometrial approach for myomectomy during caesarean section: a case report

Zhu Liang¹, Fang He¹()

Received:2022-03-07 Published:2022-11-18
Corresponding author: Fang He

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患者27岁，孕1产0，因"停经31⁺⁵周，反复阴道流血3个月，增多3 h"于2021年7月25日收入广州医科大学附属第三医院。既往史：2012年患者因左侧卵巢囊肿于外院行开腹左侧卵巢切除术。2018年因右侧卵巢囊肿在我院行开腹右侧卵巢囊肿剔除术，术中发现子宫后壁下段肌壁间可扪及一结节，大小约4 cm×3 cm×3 cm，质硬，边界清楚，考虑子宫肌瘤可能性大。术中考虑子宫肌瘤位置较深，若剔除肌瘤，孕期胎盘植入性疾病、子宫破裂等风险升高，故暂不剔除子宫肌瘤。术后患者定期复查。2020年6月18日我院超声提示后壁可见一类圆形低回声团，大小约70 mm×53 mm，边界清，内部回声欠均匀(图1)。本次妊娠为自然受孕，末次月经2020年12月15日，孕19周开始出现反复阴道出血共11次，每次量约10 ml，间隔时间1~2周不等。曾分别于孕18⁺⁶周、孕25⁺⁵周因无痛性阴道流血，考虑"前置胎盘伴出血"于我院住院治疗，予补充铁剂、预防感染，促胎肺成熟等处理。

图1 子宫肌瘤患者孕前经阴道超声检查图像。子宫前位，形态不规则，宫腔线清晰，后壁可见一类圆形低回声团，大小约70 mm×53 mm，边界清，内部回声欠均匀

图2 子宫肌瘤患者妊娠28⁺⁶周磁共振成像检查图像。子宫体积增大，胎盘(左侧箭头)位于子宫前壁，胎盘下段覆盖宫颈内口，与子宫肌层分界清，未见明显胎盘植入征象。子宫右后下壁肌层内类圆形长T1混杂T2肿块影(右侧箭头)，大小约为99.4 mm×70.4 mm×97.5 mm(左右径×前后径×上下径)，边界清晰，羊膜囊受压

图3 子宫肌瘤患者剖宫产经子宫内膜肌瘤剔除术前图片。分别可见右下壁肌壁间肌瘤、子宫内膜层及子宫肌层

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