Elbanna Wael Saad, Elkaw Asmaa Khedr, Elabd Mostafa Mahmoud
Obstetrics and Gynaecology Department, Hayat Women Care Center, Cairo, Egypt.
Int J Womens Health. 2025 Jul 25;17:2313-2323. doi: 10.2147/IJWH.S528452. eCollection 2025.
Leiomyoma is the most common benign tumor of the female genital tract. It may develop subserous, intramural, or submucous. The submucous subtype accounts for 5% of all cases, and it may become pedunculated or prolapse outside the uterine cavity, resulting in vaginal bleeding and pelvic pain, significantly impacting the quality of life, especially for larger leiomyomas. The management of such cases may require vaginal access, which may disrupt hymen integrity and is not accepted in conservative communities. Here, we present an innovative hymen-conserving Laparoscopic-And-Suprapubic Hysteroscopic Approach (LASHA) via anterior colpotomy and myomectomy for endometrial cavity exploration and management of a prolapsed pedunculated cervicovaginal leiomyoma in a virgin patient. A 30-year-old virgin presented to the clinic with heavy menstrual bleeding for the past 6 months. Abdominal ultrasound showed an enlarged uterus with multiple uterine myomas; the largest one was in the cervicovaginal zone, filling the vagina, showing a solid hypo-echoic mass, well delineated, filling the vaginal margins, and suggesting a prolapsed, pedunculated cervicovaginal leiomyoma (5.7x6.6x 8.3 cm). Other subserosal and intramural myomas ranged from 2 to 7 cm. The LASHA approach was decided to preserve the hymen's integrity based on the patient's desire, resulting in a successful tumor excision. In summary, the LASHA approach of a prolapsed, pedunculated cervicovaginal leiomyoma is an adequate, safe, and socially accepted alternative in conservative societies. Therefore, the indications of laparoscopy could be extended to endometrial cavity exploration and managing cervicovaginal leiomyoma in virgin women rejecting vaginal approaches. However, this technique necessitates adequate equipment and skills in laparoscopic surgery.
平滑肌瘤是女性生殖道最常见的良性肿瘤。它可发生于浆膜下、肌壁间或黏膜下。黏膜下亚型占所有病例的5%，可形成蒂状或脱出宫腔，导致阴道出血和盆腔疼痛，严重影响生活质量，尤其是较大的平滑肌瘤。此类病例的治疗可能需要经阴道途径，这可能会破坏处女膜完整性，在保守社区不被接受。在此，我们介绍一种创新的保留处女膜的腹腔镜联合耻骨上宫腔镜方法（LASHA），通过前穹窿切开术和肌瘤切除术，用于处女患者的子宫内膜腔探查和处理脱垂的带蒂宫颈阴道平滑肌瘤。一名30岁处女因过去6个月月经过多就诊。腹部超声显示子宫增大，有多个子宫肌瘤；最大的一个位于宫颈阴道区，充满阴道，呈实性低回声肿块，边界清晰，占据阴道边缘，提示为脱垂的带蒂宫颈阴道平滑肌瘤（5.7×6.6×8.3 cm）。其他浆膜下和肌壁间肌瘤大小在2至7 cm之间。基于患者的意愿，决定采用LASHA方法以保留处女膜完整性，肿瘤切除成功。总之，对于脱垂的带蒂宫颈阴道平滑肌瘤，LASHA方法在保守社会中是一种合适、安全且被社会接受的替代方法。因此，腹腔镜检查的适应证可扩展至子宫内膜腔探查和处理拒绝经阴道途径的处女女性的宫颈阴道平滑肌瘤。然而，该技术需要具备足够的腹腔镜手术设备和技能。
