妊娠早期巨大子宫肌瘤术后分娩1例并文献复习

doi:10.6040/j.issn.1671-7554.0.2022.0981

摘要/Abstract

摘要： 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。

关键词: 妊娠, 子宫肌瘤切除, 剖宫产, 经阴分娩, 催引产

Abstract: 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⁺⁶ weeks 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.

Key words: Pregnancy, Myomectomy, Cesarean section, Vaginal delivery, Induction of labor

中图分类号:

R714.2

张红媛,顾永忠. 妊娠早期巨大子宫肌瘤术后分娩1例并文献复习[J]. 山东大学学报 (医学版), 2023, 61(1): 69-73.

ZHANG Hongyuan, GU Yongzhong. Vaginal delivery after myomectomy in the first trimester of pregnancy: a case report and literature review[J]. Journal of Shandong University (Health Sciences), 2023, 61(1): 69-73.

参考文献

[1] 子宫肌瘤的诊治中国专家共识专家组. 子宫肌瘤的诊治中国专家共识[J]. 中华妇产科杂志,2017,52(12): 793-800.
[2] Practice Committee of the American Society for Reproductive Medicine. Electronic address: ASRM@asrm.org; Practice Committee of the American Society for Reproductive Medicine. Removal of myomas in asymptomatic patients to improve fertility and/or reduce miscarriage rate: a guideline[J]. Fertil Steril, 2017, 108(3): 416-425.
[3] 贾颖洁,姚勤. 子宫肌瘤剔除术后妊娠与子宫肌瘤合并妊娠的妊娠结局对照研究[J]. 临床和实验医学杂志, 2020, 19(3): 323-326. JIA Yingjie, YAO Qin. Comparative study of pregnancy outcome between pregnancy after myomectomy and pregnancy with aterine fibroids [J]. Journal of Clinical and Experimental Medicine, 2020, 19(3): 323-326.
[4] 薛智方,吴跃芹,王细先,等. 子宫肌瘤患者孕产时并发症、分娩结局及新生儿结局分析[J]. 医学综述, 2018, 24(22): 4573-4576. XUE Zhifang, WU Yueqin, WANG Xixian, et al. Complications pregnancy and neonatal outcome of patients with uterine fibroids [J]. Medical Recapitulate, 2018, 24(22): 4573-4576.
[5] 马丽. 278例子宫肌瘤患者妊娠及分娩情况分析[J]. 山东医药, 2016, 56(19): 81-83.
[6] Barinov SV, Tirskaya YI, Lazareva OV, et al. Pregnancy outcomes in women with large uterine fibroids [J]. J Matern Fetal Neonatal Med, 2022, 35(25): 5369-5374.
[7] Do gan S, Özyüncü Ö, Atak Z. Fibroids during pregnancy: effects on pregnancy and neonatal outcomes [J]. J Reprod Med, 2016, 61(1-2): 52-57.
[8] Diakosavvas M, Angelou K, Fasoulakis Z, et al. Myomectomy during pregnancy; diagnostical dilemmas: two case reports and a systematic review of the literature [J]. J Obstet Gynaecol, 2022, 42(5): 757-765.
[9] Allameh Z, Allameh T. Successful myomectomy in the second trimester of pregnancy[J]. Adv Biomed Res, 2019, 8: 60. doi: 10.4103/abr.abr_236_18.
[10] Jhalta P, Negi SG, Sharma V. Successful myomectomy in early pregnancy for a large asymptomatic uterine myoma: case report [J]. Pan Afr Med J, 2016, 24: 228. doi: 10.11604/pamj.2016.24.228.9890.
[11] 陈灵芝,詹瑞玺,尹玲,等. 妊娠中期腹腔镜手术切除带蒂浆膜下子宫肌瘤一例[J]. 中华妇产科杂志, 2020, 55(9): 640-642.
[12] 徐铭军,吉嘉炜. 妊娠期妇科肿瘤手术的麻醉处理[J]. 中国实用妇科与产科杂志, 2018, 34(10): 1095-1097. XU Mingjun, JI Jiawei. Anesthesia during surgery for gynecologic tumors in pregnancy [J]. Chinese Journal of Practical Gynecology and Obstetrics, 2018, 34(10): 1095-1097.
[13] 洪燕语,贺晶. 子宫肌瘤剔除术后再妊娠的产科管理[J]. 中华妇产科杂志, 2020, 10: 729-732. doi: 10.3760/cma.j.cn112141-20200622-00524.
[14] Gambacorti-Passerini Z, Gimovsky AC, Locatelli A, et al. Trial of labor after myomectomy and uterine rupture: a systematic review[J]. Acta Obstet Gynecol Scand, 2016, 95(7): 724-734.
[15] Mahalingam M, Hu M, Schointuch M, et al. Uterine myomas: effect of prior myomectomy on pregnancy outcomes [J]. J Matern Fetal Neonatal Med, 2022, 35(25): 8492-8497.
[16] Milazzo GN, Catalano A, Badia V, et al. Myoma and myomectomy: poor evidence concern in pregnancy[J]. J Obstet Gynaecol Res, 2017, 43(12): 1789-1804.
[17] 中华医学会妇产科学分会产科学组. 妊娠晚期促子宫颈成熟与引产指南(2014)[J]. 中华妇产科杂志, 2014, 49(12): 881-885.
[18] No authors listed. Practice Bulletin No. 184: Vaginal Birth After Cesarean Delivery [J]. Obstet Gynecol, 2017, 130(5): e217-e233.
[19] 柯亚亚,白宇翔,漆洪波. 美国妇产科医师学会“晚期足月和过期妊娠指南2014版”要点解读[J]. 中国实用妇科与产科杂志, 2015, 31(2): 105-108.

相关文章 15

[1]	韩馨玮,牛月,魏代敏. 激素替代方案准备内膜的冻胚移植前雌激素治疗时间对新生儿体质量的影响[J]. 山东大学学报 (医学版), 2025, 63(11): 46-52.
[2]	王瑞,于康,刘燕萍. 维生素K₂与妊娠及妊娠相关疾病的研究进展[J]. 山东大学学报 (医学版), 2024, 62(8): 9-17.
[3]	杜娟,李秀芳,李元美,王慧丹. 孕康颗粒对冻融胚胎移植周期妊娠结局的影响[J]. 山东大学学报 (医学版), 2024, 62(7): 84-90.
[4]	赵振东,张红媛,王谢桐. 上腹部占位的孕妇确诊为糖原累积症Ia型1例[J]. 山东大学学报 (医学版), 2024, 62(5): 121-124.
[5]	林欣仪,黄艳茜,邱嫔,邓高丕. 残角子宫侧输卵管妊娠1例并文献分析[J]. 山东大学学报 (医学版), 2024, 62(4): 116-119.
[6]	曹丹凤,李慧. 儿童期不良经历对妊娠期抑郁症状的影响:母胎依恋的中介作用[J]. 山东大学学报 (医学版), 2024, 62(3): 87-91.
[7]	赵圣蕊,曲慧灵,许鑫鑫,张芳芳,颜磊. 体外受精/卵胞浆内单精子注射-胚胎移植后稽留流产采用药物流产和清宫术效果比较[J]. 山东大学学报 (医学版), 2024, 62(2): 69-74.
[8]	李军秀,袁莹莹,黄凌燕,赵君利. 子宫内膜CD38表达对胚胎移植前抗炎治疗的临床价值[J]. 山东大学学报 (医学版), 2023, 61(8): 54-60.
[9]	刘昶,王倩男,张悦,陈忠绍,褚然,姚舒. 卵巢交界性肿瘤保留生育功能术后肿瘤预后及妊娠结局[J]. 山东大学学报 (医学版), 2023, 61(8): 61-66.
[10]	许月明,张杰,姜蕾,尹力,赵畔,许欣,郝桂敏. 扳机日孕酮升高与获卵数对辅助生殖技术新鲜周期妊娠结局的影响[J]. 山东大学学报 (医学版), 2023, 61(5): 44-50.
[11]	执笔专家: 班艳丽, 赵颖, 李桦, 刘薇, 荣风年, 赵淑萍, 崔保霞. 剖宫产子宫瘢痕妊娠实用临床分型诊治专家共识[J]. 山东大学学报 (医学版), 2023, 61(11): 1-10.
[12]	宋敏,曹鲁泉,吴利龙,吴淑霞,刘静,张娟,刘翠英. 9例产科A族链球菌感染临床分析[J]. 山东大学学报 (医学版), 2023, 61(11): 89-95.
[13]	张丽霞,田一正,吕尚格,张亚男,颜磊. GnRH-a预处理对子宫内膜异位症患者替代方案冻胚移植结局的影响[J]. 山东大学学报 (医学版), 2023, 61(10): 63-68.
[14]	慈倩倩,武胜英,万秋花,马运荣,赵建文,张健. 10 265例高龄孕妇的产前筛查与诊断方法分析[J]. 山东大学学报 (医学版), 2023, 61(1): 51-57.
[15]	李玉风,刘超越,朱晓波,薛江,王一彪. 妊娠同族免疫性肝病-新生儿血色病1例[J]. 山东大学学报 (医学版), 2023, 61(1): 118-120.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed