Nassif Joseph, Nahouli Hasan, Khalil Ali, Mikhael Elie, Gharzeddine Walid, Ghaziri Ghina
Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Riad El-Solh, Beirut, Lebanon.
Faculty of Medicine, American University of Beirut Medical Center, Riad El-Solh, Beirut, Lebanon.
J Minim Invasive Gynecol. 2017 Sep-Oct;24(6):1037-1039. doi: 10.1016/j.jmig.2017.04.024. Epub 2017 May 6.
Laparoscopic myomectomy, a minimally invasive procedure performed for the management of uterine leiomyomas, involves a challenging aspect: excessive local bleeding. Hemorrhage control during laparoscopic myomectomy can be achieved through the use of a wide range of vasoconstrictors, including epinephrine. Epinephrine is frequently used for the control of local bleeding during surgery; however, it has been associated with several complications. In this case report, we present a rare and unique case of stress-induced cardiomyopathy, also known as Takotsubo cardiomyopathy (TC), caused by intramyomal injection of epinephrine during laparoscopic myomectomy. TC is a transient type of cardiomyopathy associated with a reversible regional systolic and diastolic dysfunction of the left ventricle as well as various abnormal wall motions, and is often indistinguishable from myocardial infarction. TC is more prevalent in women than in men and has been linked to supraphysiological levels of plasma catecholamine. Although epinephrine is an effective vasoconstrictor used to control bleeding, it is potentially associated with adverse events that should be thoroughly investigated within the field of gynecology and its application to laparoscopic myomectomy.
腹腔镜子宫肌瘤切除术是一种用于治疗子宫平滑肌瘤的微创手术，它存在一个具有挑战性的问题：局部出血过多。腹腔镜子宫肌瘤切除术中的出血控制可通过使用多种血管收缩剂来实现，包括肾上腺素。肾上腺素在手术中常用于控制局部出血；然而，它与多种并发症有关。在本病例报告中，我们呈现了一例罕见且独特的应激性心肌病病例，也称为Takotsubo心肌病（TC），该病例由腹腔镜子宫肌瘤切除术中肌内注射肾上腺素引起。TC是一种短暂性心肌病，与左心室可逆性局部收缩和舒张功能障碍以及各种异常壁运动相关，且常与心肌梗死难以区分。TC在女性中比男性更常见，并且与血浆儿茶酚胺超生理水平有关。尽管肾上腺素是一种用于控制出血的有效血管收缩剂，但它可能与不良事件相关，在妇科领域及其在腹腔镜子宫肌瘤切除术中的应用方面应进行深入研究。
