Vimercati Antonella, Del Vecchio Vittoria, Chincoli Annarosa, Malvasi Antonio, Cicinelli Ettore
Department of Biomedical and Human Oncological Science (DIMO), 2nd Unit of Obstetrics and Gynaecology, University of Bari, Bari, Italy.
Santa Maria Hospital, GVM Care & Research, Bari, Italy.
Case Rep Obstet Gynecol. 2017;2017:1404815. doi: 10.1155/2017/1404815. Epub 2017 Dec 20.
We describe two cases of uterine rupture in pregnancy after laparoscopic myomectomy and analyze all the aetiological factors involved in this circumstance according to the recent literature, focusing above all on the surgical procedures and the characteristics of the excised myomas. The two cases of uterine rupture in pregnancy following laparoscopic myomectomy occurred at 36 and 18 weeks of gestation, respectively. Both women had undergone laparoscopic multiple myomectomy and uterine rupture occurred along the isthmic myomectomy scars, despite the fact that compliance with all the recent technical surgical recommendations for the previous laparoscopic multiple myomectomy had been fully observed. In our cases we identified the isthmic localization, size of the excised myomas (≥4 cm), and individual characteristics of the healing process as possible risk factors for "a real complication." Larger studies and robust case-control analyses are needed to draw reliable conclusions; special care should be paid when performing laparoscopic myomectomy in women planning a later pregnancy.
我们描述了两例腹腔镜子宫肌瘤切除术后妊娠子宫破裂的病例，并根据近期文献分析了这种情况下所有涉及的病因因素，尤其着重于手术操作以及切除肌瘤的特征。这两例腹腔镜子宫肌瘤切除术后妊娠子宫破裂分别发生在妊娠36周和18周。两名女性均接受了腹腔镜多发性子宫肌瘤切除术，子宫破裂发生在峡部肌瘤切除瘢痕处，尽管之前的腹腔镜多发性子宫肌瘤切除术已完全遵循了所有最新的技术手术建议。在我们的病例中，我们确定峡部定位、切除肌瘤的大小（≥4厘米）以及愈合过程的个体特征是“真正并发症”的可能危险因素。需要进行更大规模的研究和有力的病例对照分析才能得出可靠结论；对于计划日后妊娠的女性进行腹腔镜子宫肌瘤切除术时应格外小心。
