Roh Chul Kyu, Kwon Hyuk-Jae, Jung Min Jung
Department of Surgery, National Police Hospital, Seoul 05715, South Korea.
Department of Surgery, Ajou University School of Medicine, Suwon 16499, South Korea.
World J Clin Cases. 2022 Mar 26;10(9):2895-2900. doi: 10.12998/wjcc.v10.i9.2895.
Laparoscopic myomectomy is increasingly used for resecting gynecological tumors. Leiomyomas require morcellation for retrieval from the peritoneal cavity. However, morcellated fragments may implant on the peritoneal cavity during retrieval. These fragments may receive a new blood supply from an adjacent structure and develop into parasitic leiomyomas. Parasitic leiomyomas can occur spontaneously or iatrogenically; however, trocar-site implantation is an iatrogenic complication of laparoscopic uterine surgery. We describe a parasitic leiomyoma in the trocar-site after laparoscopic myomectomy with power morcellation.
A 50-year-old woman presented with a palpable abdominal mass without significant medical history. The patient had no related symptoms, such as abdominal pain. Computed tomography findings revealed a well-defined contrast-enhancing mass measuring 2.2 cm, and located on the trocar site of the left abdominal wall. She had undergone laparoscopic removal of uterine fibroids with power morcellation six years ago. The differential diagnosis included endometriosis and neurogenic tumors, such as neurofibroma. The radiologic diagnosis was a desmoid tumor, and surgical excision of the mass on the abdominal wall was successfully performed. The patient recovered from the surgery without complications. Histopathological examination revealed that the specimen resected from the trocar site was a uterine leiomyoma.
Clinicians should consider the risks and benefits of laparoscopic laparotomic myomectomy for gynecological tumors. Considerable caution must be exercised for morcellation to avoid excessive tissue fragmentation.
腹腔镜下子宫肌瘤切除术越来越多地用于切除妇科肿瘤。子宫肌瘤需要粉碎后从腹腔取出。然而，粉碎后的组织块在取出过程中可能种植于腹腔。这些组织块可能从相邻结构获得新的血液供应并发展为寄生性平滑肌瘤。寄生性平滑肌瘤可自发或医源性发生；然而，套管针穿刺部位种植是腹腔镜子宫手术的一种医源性并发症。我们报告一例在使用电动粉碎器行腹腔镜子宫肌瘤切除术后套管针穿刺部位出现的寄生性平滑肌瘤。
一名50岁女性，腹部可触及肿块，无重要病史。患者无腹痛等相关症状。计算机断层扫描结果显示一个边界清晰、增强扫描有强化的肿块，大小为2.2 cm，位于左腹壁套管针穿刺部位。她6年前曾接受过使用电动粉碎器的腹腔镜下子宫肌瘤切除术。鉴别诊断包括子宫内膜异位症和神经源性肿瘤，如神经纤维瘤。影像学诊断为硬纤维瘤，成功地对腹壁肿块进行了手术切除。患者术后恢复顺利，无并发症。组织病理学检查显示，从套管针穿刺部位切除的标本为子宫平滑肌瘤。
临床医生应考虑腹腔镜和开腹子宫肌瘤切除术治疗妇科肿瘤的风险和益处。在粉碎操作时必须格外小心，以避免组织过度破碎。
