Malik Neeru, Sidhar Meenakshi, Jain Sandhya, Agrawal Neha, Madan Nikita
Obstetrics and Gynaecology, Dr. Baba Saheb Ambedkar Medical College and Hospital, New Delhi, IND.
Pathology, Dr. Baba Saheb Ambedkar Medical College and Hospital, New Delhi, IND.
Cureus. 2025 Apr 22;17(4):e82788. doi: 10.7759/cureus.82788. eCollection 2025 Apr.
Cervical fibroids are rare, benign tumors. The treatment of uterine fibroids is well-established, with standard treatment guidelines in place; however, there remains a lack of consensus on a standardized approach for cervical fibroids. A small prolapsing fibroid polyp may be removed vaginally, and a hysteroscope can be used in such cases to identify and ligate the pedicle. However, large cervical fibroids present a surgical challenge. Myomectomy is the cornerstone for the surgical management of cervical fibroids in women who wish to preserve their uterus. An enlarged cervix alters the anatomy of adjacent vital structures like the ureters, bladder, rectum, and uterine vessels, increasing the risk of injury to these structures. Due to the narrow operating field and the potential for injury, preoperative catheterization of the ureters through double-J (DJ) stenting is performed to delineate their course prior to surgery. Here, we report a series of cases in which intracervical fibroids, visible vaginally as a cervical protuberance, were enucleated vaginally using Bonney's principles. The base of the fibroid was clamped and ligated, followed by obliteration of the space and reconstruction of the cervix. Injection of vasopressin was unavailable in our resource-limited hospital; therefore, adrenaline was injected in a 1:200,000 dilution into the fibroid capsule intraoperatively to minimize blood loss. This method of enucleation minimizes the risk of injury to adjacent organs since the dissection occurs intracapsularly. Preoperative prophylactic DJ stenting was also not needed. Despite the lack of advanced medical options to reduce fibroid size and vascularity, such as preoperative gonadotropin-releasing hormone (GnRH) analogues and uterine artery embolization, in our low-resource setting, our technique of vaginal myomectomy effectively managed the challenges presented by large intracervical fibroids while preserving fertility. The only limitation was that fibroids that were not palpable through the cervical lips could not be enucleated using this approach.
宫颈肌瘤是罕见的良性肿瘤。子宫肌瘤的治疗方法已很成熟，有标准的治疗指南；然而，对于宫颈肌瘤的标准化治疗方法仍缺乏共识。较小的脱垂肌瘤息肉可经阴道切除，这种情况下可使用宫腔镜来识别并结扎蒂部。然而，较大的宫颈肌瘤则带来手术挑战。对于希望保留子宫的女性，肌瘤切除术是宫颈肌瘤手术管理的基石。宫颈增大改变了输尿管、膀胱、直肠和子宫血管等相邻重要结构的解剖结构，增加了这些结构受损的风险。由于手术视野狭窄且有损伤风险，术前通过双J（DJ）支架置入术对输尿管进行插管，以在手术前明确其走行。在此，我们报告一系列病例，其中宫颈内肌瘤经阴道可见呈宫颈突出，采用邦尼原则经阴道摘除。肌瘤基部钳夹并结扎，随后封闭间隙并重建宫颈。在我们资源有限的医院无法获得加压素注射剂；因此，术中将肾上腺素以1:200,000的稀释度注射到肌瘤包膜内以尽量减少失血。这种摘除方法将相邻器官损伤的风险降至最低，因为剥离是在包膜内进行的。术前也无需预防性DJ支架置入术。尽管在我们资源匮乏的环境中缺乏如术前促性腺激素释放激素（GnRH）类似物和子宫动脉栓塞等先进的缩小肌瘤大小和减少血管供应的医疗选择，但我们的经阴道肌瘤切除术技术有效地应对了大型宫颈内肌瘤带来的挑战，同时保留了生育能力。唯一的局限性是无法通过宫颈唇触及的肌瘤不能用这种方法摘除。
