Department of Gynecology, Vila Nova de Gaia/Espinho Hospital Center, Vila Nova de Gaia, Portugal.
J Minim Invasive Gynecol. 2012 Nov-Dec;19(6):775-9. doi: 10.1016/j.jmig.2012.07.001.
We describe a conservative laparoscopic approach to treatment of a perforated pyomyoma after uterine artery embolization. A 36-year-old woman came to our emergency department 8 weeks after undergoing uterine artery embolization. She reported painful abdominal cramps. Physical examination revealed fever, tachycardia, hypotension, abdominal pain with rebound tenderness and pain during bimanual examination. Ultrasonography showed a fundal/subserosal leiomyoma and a moderate amount of fluid in the abdominal cavity. Because the patient desired preservation of the uterus, a laparoscopic approach was used for drainage and lavage of a perforated pyomyoma. The patient had an uneventful recovery and remained well at follow-up visits. Second-look diagnostic laparoscopy enabled treatment of the adhesions formed and revealed patent fallopian tubes. Surgery has been the primary approach to pyomyoma. However, hysterectomy leads to irreversible sterility and myomectomy can be difficult to perform. Therefore, there is need for a less invasive intervention in women who seek conservative treatment. Recently, computed tomography-guided drainage was successfully performed in two patients with pyomyoma. To our knowledge, this is the first report of a successful conservative laparoscopic approach to pyomyoma.
我们描述了一种经保守的腹腔镜方法治疗子宫动脉栓塞术后穿孔性子宫肌瘤。一名 36 岁女性在子宫动脉栓塞术后 8 周来到我们的急诊部。她报告腹痛性痉挛。体格检查显示发热、心动过速、低血压、腹痛伴反跳痛和双合诊时疼痛。超声检查显示底/浆膜下子宫肌瘤和中等量腹腔积液。由于患者希望保留子宫，因此采用腹腔镜方法对穿孔性子宫肌瘤进行引流和灌洗。患者恢复顺利，随访时情况良好。再次行腹腔镜检查可治疗形成的粘连，并显示输卵管通畅。手术一直是治疗子宫肌瘤的主要方法。然而，子宫切除术会导致不可逆转的不育，子宫肌瘤切除术也可能难以进行。因此，对于寻求保守治疗的女性，需要一种微创干预方法。最近，两名患有子宫肌瘤的患者成功地进行了 CT 引导下引流。据我们所知，这是首例成功的保守腹腔镜治疗子宫肌瘤的报告。
