Tjokroprawiro Brahmana Askandar, Saraswati Wita, Yuliati Indra
Department of Obstetrics and Gynecology, Dr. Soetomo General Academic Hospital, Medical Faculty, Universitas Airlangga, Surabaya, Indonesia.
Am J Case Rep. 2021 Apr 26;22:e931051. doi: 10.12659/AJCR.931051.
BACKGROUND No standard guidelines have been specified for a cesarean myomectomy, and several centers remain divided on the justification to perform this procedure, especially for large fibroids. Only a few case reports have been published of cesarean myomectomy for large fibroids. Here, we report 2 cases of successful cesarean myomectomies for large fibroids (>15 cm) during the 38th week of pregnancy. CASE REPORT We encountered 2 primigravida patients, aged 34 and 36 years, respectively, with large fibroids >15 cm in diameter. Using the Pfannenstiel incision, we performed cesarean myomectomies in both patients at term pregnancy. The surgeries were performed by a gynecologic oncologist in a tertiary hospital. Both patients experienced a postoperative decrease in hemoglobin but neither required a blood transfusion. Three days after the operation, the patients were discharged from the hospital in good condition. One year later, the patients and their babies continued to be in good health. The patients did not experience chronic pelvic pain or menstrual abnormalities. Neither patient is currently planning another pregnancy. CONCLUSIONS Based on our report, it may be assumed that cesarean myomectomy for a large fibroid (even for fibroids >15 cm in diameter) is safe if performed by experts in a tertiary hospital. Further larger studies of cesarean myomectomy of large fibroids are required to confirm the safety of this procedure.
剖宫产同时行肌瘤切除术尚无标准指南，几个中心对于实施该手术的合理性仍存在分歧，尤其是对于大的肌瘤。仅有少数关于大肌瘤剖宫产肌瘤切除术的病例报告发表。在此，我们报告2例在妊娠38周时成功进行大肌瘤（>15 cm）剖宫产肌瘤切除术的病例。病例报告：我们遇到2例初产妇患者，年龄分别为34岁和36岁，患有直径>15 cm的大肌瘤。采用耻骨联合上横切口，我们在足月妊娠时对两名患者均进行了剖宫产肌瘤切除术。手术由一家三级医院的妇科肿瘤学家实施。两名患者术后血红蛋白均下降，但均未需要输血。术后三天，患者状况良好出院。一年后，患者及其婴儿继续保持健康。患者未出现慢性盆腔疼痛或月经异常。两名患者目前均未计划再次怀孕。结论：基于我们的报告，可以假定如果由三级医院的专家进行，大肌瘤（即使直径>15 cm的肌瘤）剖宫产肌瘤切除术是安全的。需要进一步对大肌瘤剖宫产肌瘤切除术进行更大规模的研究以证实该手术的安全性。
