Lin B, Akiba Y, Iwata Y
Department of Obstetrics and Gynecology, Kawasaki Municipal Hospital, Kawasaki, Japan.
Fertil Steril. 2000 Nov;74(5):1035-8. doi: 10.1016/s0015-0282(00)01548-x.
To report one-step resectoscopic removal of submucous myomas that were pushed back into the muscular layer by increased intrauterine pressure during hysteroscopic procedures.
Case report.
Kawasaki Municipal Hospital, Kawasaki, Japan.
PATIENT(S): Two infertile women presenting with menorrhagia in whom submucous myoma with a broad base was diagnosed.
INTERVENTION(S): One patient was pretreated with GnRH agonist for 4 months; the other patient did not receive this treatment. Resectoscopic myomectomies were performed under close sonographic monitoring.
MAIN OUTCOME MEASURE(S): Clinical symptoms and conception status.
RESULT(S): Tumor sinking occurred during the hysteroscopic procedures, but complete resectoscopic removal of the submucous myomas was achieved under sonographic and hysteroscopic visualization. One patient experienced hyponatremia but recovered after conservative treatment. Both patients conceived after myoma removal.
CONCLUSION(S): Sinking myomas, which may cause infertility, can be removed with a one-step hysteroscopic procedure. Sinking of submucous myomas during hysteroscopy might be caused by pretreatment with GnRH agonist and by increased intrauterine pressure during hysteroscopy. We recommend that intrauterine pressure be <45 mmHg, equivalent to hanging a bag of fluid under gravity control 70 cm above the patient's uterus, at the beginning of operations for sinking myomas.
报告在宫腔镜手术期间，通过宫腔镜一步切除因宫腔内压力增加而被推回肌层的黏膜下肌瘤。
病例报告。
日本川崎市川崎市立医院。
两名因月经过多就诊的不孕女性，均被诊断为有宽基底的黏膜下肌瘤。
一名患者接受了4个月的促性腺激素释放激素（GnRH）激动剂预处理；另一名患者未接受此治疗。在超声密切监测下进行宫腔镜肌瘤切除术。
临床症状和受孕情况。
宫腔镜手术期间肌瘤出现下沉，但在超声和宫腔镜直视下成功通过宫腔镜将黏膜下肌瘤完全切除。一名患者出现低钠血症，但经保守治疗后康复。两名患者肌瘤切除后均受孕。
可能导致不孕的下沉肌瘤可通过一步宫腔镜手术切除。宫腔镜检查期间黏膜下肌瘤下沉可能是由GnRH激动剂预处理以及宫腔镜检查期间宫腔内压力增加所致。我们建议，在进行下沉肌瘤手术开始时，宫腔压力应＜45 mmHg，相当于在患者子宫上方70 cm处重力控制下悬挂一袋液体。
