Kwek Lee Koon, Wee-Stekly Wei-Wei, Chern Su Min Bernard
Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore.
Department of Minimally Invasive Surgery, KK Women's and Children's Hospital, Singapore.
BMJ Case Rep. 2018 Feb 7;2018:bcr-2017-222608. doi: 10.1136/bcr-2017-222608.
A 35-year-old woman presented with an abdominal mass found incidentally on an ultrasound scan. On examination, the uterus was mobile and 14 weeks in size. Further imaging showed a large subserosal pedunculated fibroid, and she was counselled for laparoscopic myomectomy, morcellation in a bag, kept in open view. Intraoperatively, the mass was noted to be arising from the right ovarian ligament instead of the uterus, and decision was made to convert to open surgery. This case highlights important issues of consent-taking preoperatively and critical points to note regarding change in operative consent intraoperatively. This also highlights the importance of multidisciplinary cooperation as the decision had to be made with inputs made from gynae-oncology and pathology.
一名35岁女性因超声检查偶然发现腹部肿块前来就诊。检查时,子宫可活动,大小如孕14周。进一步影像学检查显示一个巨大的浆膜下带蒂肌瘤,建议她行腹腔镜子宫肌瘤切除术,在袋内粉碎肌瘤,并保持在视野中。术中发现肿块起源于右侧卵巢韧带而非子宫,于是决定转为开腹手术。该病例凸显了术前知情同意的重要问题以及术中手术同意变更时需要注意的关键点。这也凸显了多学科合作的重要性,因为该决定必须综合妇科肿瘤学和病理学的意见做出。