宫腔镜下切除子宫巨大壁间内突肌瘤1例报告

Hysteroscopic Resection of Giant Intramural Internal Convex Myoma:Case Report

本文报道1例36岁患者,重度贫血、子宫巨大壁间内突肌瘤,给予口服小剂量米非司酮预处理12.5 mg,每日1次,连续5个月。持续闭经5个月,无不适症状,贫血纠正后B超监护下宫腔镜先下后上法在肌瘤假包膜内电切、钳夹、牵引、旋转,清除8 cm×9 cm子宫巨大壁间内突肌瘤,重约160 g,手术时间110 min。术中使用5%葡萄糖灌流液20 000 ml,灌流液吸收量600 ml,出血400 ml。术后病理:子宫平滑肌瘤,富含细胞。术后2 d顺利出院。术后3个月患者月经量仍多,宫腔镜检查提示:在原电切位置再次生长一6 cm×7 cm球形肿物,经阴道行子宫全切术。术后病理示子宫平滑肌瘤,富含细胞,子宫内膜呈分泌期改变,子宫颈慢性炎。我们认为术前每日口服12.5 mg米非司酮3~5个月,可以明显降低宫腔镜电切直径>5 cm的子宫黏膜下肌瘤或子宫壁间内突肌瘤的手术难度及风险。

A 36-year-old woman,presented with severe anemia and diagnosed as having a giant intramural internal convex myoma,was treated in this center.The myoma was pretreated with a low dose of mifepristone as 12.5 mg daily for 5 months.In the meantime,amenorrhea sustained for 5 months without uncomfortable symptoms.After anemia correction,hysteroscopic resection under B-ultrasound monitoring was performed to remove the huge myoma inside the pseudocapsule by means of gradually and progressively cutting from bottom to the top.The myoma was 8 cm ×9 cm in size and 160 g in weight.The hysteroscopic surgery,composed of electrotomy,forceps clamping,drag and twist,lasted for 110 min with 400 ml of operative blood loss.In the course of the surgery20 000 ml of 5% glucose perfusate was used,among which 600 ml was absorbed.The post-operation pathological report showed uterine leiomyoma rich in cells.The patient was discharged two days after the operation.Three months later,the patient returned to the hospital again,complaining of menorrhagia as before.Hysteroscopy revealed that a spherical neoplasm recurred in the original resection position.Thus a transvaginal hysterectomy was performed.Pathological report again showed leiomyoma rich in cells.We believe that preoperative 12.5 g of oral mifepristone daily for 3-5 months will greatly reduce the difficulty and risk of hysteroscopic myomectomy for huge submucosal or intramural myomata 〉5 cm in diameter.