Department of Obstetrics and Gynaecology, "Sirai" Hospital, 09013 Carbonia, Italy.
Arch Gynecol Obstet. 2012 Jun;285(6):1577-80. doi: 10.1007/s00404-011-2197-y. Epub 2011 Dec 30.
There are very few reports in the literature about the conservative surgical approach of large uterine myoma. The individualization of the surgery approach, the technical expertise and skill of the surgeon, the use of modern technologies/facilities could offer the optimal individualized treatment.
We performed a conservative combined surgical approach consisting of open laparoscopy myomectomy followed by laparotomy for the treatment of a very large uterine myoma of the anterior uterine wall in a 27-year-old non-pregnant woman with a history of progressive abdominal distension and symptoms related to abdomen pressure and constipation.
The myoma weighted 12.010 kg. The postoperative course was good and 20 months after surgery, the patients had a successful pregnancy with a spontaneous delivery at the 39th week of a healthy baby weighting 3.260 kg.
In the case reported here, the careful pre-surgical evaluation, the technical expertise and skill of the surgeon, the choice of a combined approach with laparoscopy and open surgery and the use of modern surgical instruments have enabled us to achieve a significant result: the preservation of the anatomical integrity of the uterus and adnexa which allowed a successful natural pregnancy with spontaneous delivery.
文献中关于大子宫肌瘤的保守手术方法的报道很少。手术方法的个体化、外科医生的技术专长和技能、现代技术/设备的应用，可以提供最佳的个体化治疗。
我们对一名 27 岁的未孕妇女采用了一种联合的保守性手术方法，该患者既往有逐渐加重的腹胀病史，伴有腹部压迫感和便秘等症状，超声检查提示前壁巨大子宫肌瘤，我们先采用开腹腹腔镜子宫肌瘤剔除术，然后再行剖腹手术。
肌瘤重 12.010kg。术后恢复良好，术后 20 个月，患者成功妊娠，于第 39 周自然分娩，新生儿健康，体重 3.260kg。
在本例中，仔细的术前评估、外科医生的技术专长和技能、腹腔镜和开腹手术联合应用的选择以及现代手术器械的应用，使我们能够取得显著的效果：保留了子宫和附件的解剖完整性，从而实现了自然妊娠和自然分娩。
