Hidayah Gita Nurul, Harzif Achmad Kemal, Noviani Astri, Tantry Harry Prawiro, Santoso Budi Iman, Situmorang Herbert
Urogynecology, Reconstructive Pelvic and Aesthetic Surgery Division, Obstetrics and Gynaecology (O & G) Department, dr. Cipto Mangunkusumo Hospital Jakarta-Faculty of Medicine Universitas Indonesia (FMUI), Indonesia.
Immunology & Reproductive Endocrinology Division, O & G Department, dr Cipto Mangunkusumo Hospital-FMUI, Indonesia.
Int J Surg Case Rep. 2023 Dec;113:109029. doi: 10.1016/j.ijscr.2023.109029. Epub 2023 Nov 11.
The pedunculated fibroid is classically managed through vaginal myomectomy. However, vaginal myomectomy cannot be safely and easily performed in all cases. We reviewed three cases of prolapsed pedunculated submucosal fibroids, each with a specific surgical difficulty.
The first case had a prolapsed pedunculated uterine fibroid in pregnancy and underwent fibroid extirpation during an emergency cesarean section through the lower uterine segment incision. The second case was a nulliparous woman with recurrent abnormal uterine bleeding due to a giant prolapsed pedunculated uterine fibroid who underwent laparotomy fibroid extirpation through posterior colpotomy, preserving the uterus. The third case had a prolapsed pedunculated uterine fibroid in perimenopause with multiple fibroids and underwent fibroid stalk excision through an isthmic incision to facilitate a safe laparotomy hysterectomy procedure.
Vaginal removal has become the standard surgical method for prolapsed pedunculated submucous fibroids. However, some possible consequences of vaginal myomectomy include severe stalk bleeding, infection, and uterus inversion induced by excessive traction. Therefore, specific approaches are needed in some circumstances.
Customised surgical approaches provided safe and efficient access to the prolapsed pedunculated fibroid stalk during myomectomy or hysterectomy.
带蒂子宫肌瘤传统上通过经阴道子宫肌瘤切除术进行治疗。然而，并非所有病例都能安全、轻松地实施经阴道子宫肌瘤切除术。我们回顾了三例脱垂的带蒂黏膜下子宫肌瘤病例，每例都有特定的手术难点。
第一例为妊娠期带蒂子宫脱垂肌瘤，在紧急剖宫产时通过子宫下段切口进行了肌瘤摘除术。第二例是一名未生育女性，因巨大脱垂带蒂子宫肌瘤反复出现异常子宫出血，通过后穹窿切开术经剖腹手术摘除肌瘤，保留了子宫。第三例是围绝经期带蒂子宫脱垂肌瘤伴多发肌瘤，通过峡部切口进行肌瘤蒂切除术，以便安全地实施剖腹子宫切除术。
经阴道切除已成为脱垂带蒂黏膜下子宫肌瘤的标准手术方法。然而，经阴道子宫肌瘤切除术的一些可能后果包括严重的蒂部出血、感染以及过度牵引导致的子宫内翻。因此，在某些情况下需要采取特定的方法。
定制的手术方法为子宫肌瘤切除术或子宫切除术期间脱垂的带蒂肌瘤蒂提供了安全有效的处理途径。
