Li Junjie, Yang Leilei, Wang Yan, He Min, Zhu Hongqiu, Huang Yefang
Traditional Chinese Medicine Department, Hunan University of Medicine General Hospital, Hunan, Huaihua, 418000, People's Republic of China.
Gynaecology, Hospital of Chengdu University of Traditional Chinese Medicine, Sichuan, Chengdu, 610072, People's Republic of China.
Int J Womens Health. 2025 Aug 4;17:2401-2412. doi: 10.2147/IJWH.S530879. eCollection 2025.
Hysteroscopic myomectomy is the first-line treatment for the removal of submucosal myoma in women facing fertility requirements. However, in the face of large diameter type 2 submucosal myoma, patients are at greater risk of complications such as uterine perforation and fluid overload during hysteroscopy. When the diameter of type 2 submucous myoma is greater than 4cm, the three-phase treatment of high intensity focused ultrasound (HIFU), drugs and hysteroscopy is effective and safe. We shared a case of a 30-year-old non-pregnant woman, who had a history of uterine submucous myoma for more than 4 years with symptoms of heavy menstruation, prolonged menstruation and secondary severe anemia. The patient's initial pelvic magnetic resonance results suggested a type 2 uterine submucous myoma with a diameter of more than 4cm. We first performed HIFU on the patient, followed by the patient's oral intake of mifepristone tablets for 3 months, and prior to hysteroscopic surgery, the patient's fibroid type was shifted to type 0, and finally successfully completed hysteroscopic myomectomy (HM). Finally, we conclude that when the diameter of type 2 submucosal myoma exceeds 4 cm, preoperative application of HIFU combined with drug treatment should be considered to maximize the reduction of fibroids, improve symptoms such as anemia and dysmenorrhea, reduce the time required for hysteroscopic surgery, and improve the safety of surgery.
宫腔镜子宫肌瘤切除术是有生育需求女性黏膜下肌瘤切除的一线治疗方法。然而，面对直径较大的2型黏膜下肌瘤，患者在宫腔镜手术期间发生子宫穿孔和液体超负荷等并发症的风险更高。当2型黏膜下肌瘤直径大于4cm时，高强度聚焦超声（HIFU）、药物和宫腔镜的三相治疗是有效且安全的。我们分享了一例30岁未孕女性的病例，该患者有子宫黏膜下肌瘤病史4年多，伴有月经过多、经期延长和继发性重度贫血症状。患者最初的盆腔磁共振结果提示为直径大于4cm的2型子宫黏膜下肌瘤。我们首先对患者进行了HIFU治疗，随后让患者口服米非司酮片3个月，在宫腔镜手术前，患者的肌瘤类型转变为0型，最终成功完成了宫腔镜子宫肌瘤切除术（HM）。最后，我们得出结论，当2型黏膜下肌瘤直径超过4cm时，应考虑术前应用HIFU联合药物治疗，以最大程度缩小肌瘤，改善贫血和痛经等症状，减少宫腔镜手术所需时间，并提高手术安全性。
