Wu Juntong, Liu Yuan, Zhang Lili, Ma Dongji, Yao Tianming, Wang Li
Department of Obstetrics and Gynecology, The 964th Hospital, Changchun, Jilin, China.
Obstetrics and Gynecology Diagnosis and Treatment Center, The Affiliated Hospital, Changchun University of Chinese Medicine, Changchun, Jilin, China.
Front Med (Lausanne). 2025 Sep 9;12:1632322. doi: 10.3389/fmed.2025.1632322. eCollection 2025.
Uterine fibroids located at cesarean section scar sites are rare and differ clinically from conventional fibroids, frequently causing abnormal uterine bleeding and infertility. Traditional surgical approaches (laparotomy, laparoscopy, or vaginal surgery) necessitate incision of the scar site, resulting in significant tissue damage. We present a successful case of hysteroscopic resection for such fibroids, demonstrating the minimally invasive advantages of this approach.
A 49-year-old multiparous woman with a history of cesarean delivery presented with a 2-year history of menorrhagia and prolonged menstrual cycles, exacerbated over the preceding month. Gynecological ultrasound revealed heterogeneous hypoechogenicity within the cervical canal, measuring approximately 5.3 cm × 3.5 cm × 3.3 cm in size. The physical examination revealed an enlarged uterus, approximately the size of 11 cm × 8 cm × 7 cm. Hematologic workup showed the hemoglobin (HGB) level of 65 g/L. Based on these examination results, a clinical diagnosis of "uterine fibroids, secondary anemia" was conducted. Hysteroscopy examination showed that the base of the uterine fibroid was attached to the scar site of the original cesarean section, without a pedicle, and the main body of the fibroid remained in the cervical canal-intraoperative definitive diagnosis: intramural fibroids at the scar site of the uterus. Therefore, a hysteroscopic approach with a bipolar resectoscope was used to remove the intramural fibroids in the scar area of the uterus. The procedure consumed 22,000 ml of fluid distension media (0.9% NaCl) and lasted for 1 h and 45 min. The postoperative pathological diagnosis was uterine leiomyoma, consistent with the preoperative diagnosis. A follow-up was conducted 3 months after surgery, and a gynecological ultrasound examination showed complete removal of uterine fibroids.
This case confirmed that hysteroscopic resection of cesarean scar intramural fibroids is a feasible, safe, and minimally invasive approach.
剖宫产瘢痕部位的子宫肌瘤较为罕见，在临床上与传统子宫肌瘤不同，常导致子宫异常出血和不孕。传统手术方法（剖腹手术、腹腔镜手术或阴道手术）需要切开瘢痕部位，会造成严重的组织损伤。我们报告了一例成功通过宫腔镜切除术治疗此类肌瘤的病例，展示了该方法的微创优势。
一名49岁经产妇，有剖宫产史，出现月经过多和月经周期延长2年，前一个月加重。妇科超声显示宫颈管内不均质低回声，大小约为5.3 cm×3.5 cm×3.3 cm。体格检查发现子宫增大，约为11 cm×8 cm×7 cm大小。血液学检查显示血红蛋白（HGB）水平为65 g/L。根据这些检查结果，临床诊断为“子宫肌瘤，继发性贫血”。宫腔镜检查显示子宫肌瘤底部附着于原剖宫产瘢痕部位，无蒂，肌瘤主体位于宫颈管内——术中明确诊断：子宫瘢痕部位肌壁间肌瘤。因此，采用双极电切镜经宫腔镜方法切除子宫瘢痕部位的肌壁间肌瘤。手术过程中使用了22000 ml液体扩张介质（0.9%氯化钠），持续1小时45分钟。术后病理诊断为子宫平滑肌瘤，与术前诊断一致。术后3个月进行随访，妇科超声检查显示子宫肌瘤已完全切除。
该病例证实宫腔镜切除剖宫产瘢痕肌壁间肌瘤是一种可行、安全且微创的方法。
