妊娠早期巨大子宫肌瘤术后分娩1例并文献复习

Vaginal delivery after myomectomy in the first trimester of pregnancy:a case report and literature review

目的探讨妊娠早期子宫肌瘤切除术的可行性及妊娠期肌瘤术后分娩方式和时机的选择。方法回顾性分析山东第一医科大学附属省立医院妊娠早期巨大子宫肌瘤切除术后足月经阴分娩1例患者的临床资料,并进行文献复习。结果患者于妊娠32 d行全麻下子宫肌瘤切除术,孕期正规产检,过程顺利,于孕41周人工破膜后经阴分娩一活婴,产后恢复好,顺利出院。结论妊娠期早期子宫肌瘤切除手术是可以尝试的,可于妊娠36~38+6周择期剖宫产。肌瘤切除过程中子宫肌层完整性未受到显著破坏者,可严密监护下阴道试产,分娩孕周可延长至41周。子宫肌瘤切除术后的催引产需谨慎,不建议40周以后的引产。

Objective To explore the feasibility of myomectomy in early pregnancy,and the choice of delivery mode and timing after myomectomy in pregnancy.Methods A retrospective analysis was performed on the clinical data of a patient with vaginal delivery after myomectomy in the first trimester of pregnancy in Shandong Provincial Hospital Affiliated to Shandong First Medical University,and the relative literature were reviwed.Results The patient underwent myomectomy under general anesthesia on the 32nd day of gestation,and underwent regular obstetric examination during pregnancy.The process went smoothly.Finally,the patient underwent vaginal delivery at the 41st week of gestation after artificial rupture of the membranes,and recovered well.Conclusion Myomectomy in early pregnancy can be tried,and elective cesarean section can be performed at 36-38+6weeks in the third trimester of pregnancy after myomectomy during pregnancy.If the integrity of myometrium is not significantly damaged during myomectomy,vaginal delivery can be tried under close supervision,and the gestational age of delivery can be extended to 41 weeks.For pregnant women who underwent myomectomy,induction of labor after 40 weeks is not recommended.