Chen Shudan, He Sili, Li Ruizhen, Cheng Chunxia
Department of Obstetrics and Gynecology, Third Xiangya Hospital, Central South University, Changsha 410013, China.
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2025 Jun 28;50(6):1099-1105. doi: 10.11817/j.issn.1672-7347.2025.240583.
Hysterectomy remains the only definitively effective treatment for diffuse uterine leiomyomatosis (DUL). However, no standardized management strategy exists for DUL patients wishing to preserve fertility. This study summarizes and analyzes 5 cases of individualized treatment in DUL patients desiring fertility preservation, aiming to provide a clinical reference for personalized management of similar patients.
We retrospectively analyzed the clinical data of 5 DUL patients with fertility intentions admitted to the Department of Obstetrics and Gynecology at Third Xiangya Hospital of Central South University. To preserve fertility, individualized treatment plans were selected based on clinical manifestations and fibroid distribution. One patient received high-intensity focused ultrasound (HIFU); one underwent hysteroscopic myomectomy (HM) combined with laparoscopic myomectomy (LRM); one underwent HIFU combined with HM and LRM; one received drug therapy combined with staged HM; and one underwent HIFU combined with staged HM and drug therapy. Treatment outcomes and pregnancy results were analyzed.
After treatment, all 5 patients showed marked improvement in menstrual volume or dysmenorrhea symptoms and significant reduction in uterine volume; mild intrauterine adhesions occurred in 3 cases. All 5 patients achieved successful pregnancy. One patient with chronic hypertension developed severe preeclampsia at 34 weeks and underwent cesarean section, while the remaining 4 delivered at term by cesarean section. Three cases of placenta accreta and 2 cases of postpartum hemorrhage occurred. During long-term follow-up, one patient underwent hysterectomy 2 years postpartum due to increased menstrual volume, while the other 4 remained stable.
Individualized treatment tailored to DUL patients' conditions can preserve fertility, support successful pregnancy, and achieve favorable pregnancy outcomes.
子宫切除术仍是弥漫性子宫平滑肌瘤病（DUL）唯一确切有效的治疗方法。然而，对于希望保留生育能力的DUL患者，尚无标准化的管理策略。本研究总结并分析5例希望保留生育能力的DUL患者的个体化治疗情况，旨在为类似患者的个性化管理提供临床参考。
我们回顾性分析了中南大学湘雅三医院妇产科收治的5例有生育意愿的DUL患者的临床资料。为保留生育能力，根据临床表现和肌瘤分布选择个体化治疗方案。1例患者接受高强度聚焦超声（HIFU）治疗；1例接受宫腔镜子宫肌瘤切除术（HM）联合腹腔镜子宫肌瘤切除术（LRM）；1例接受HIFU联合HM和LRM；1例接受药物治疗联合分期HM；1例接受HIFU联合分期HM和药物治疗。分析治疗效果和妊娠结局。
治疗后，5例患者月经量或痛经症状均有明显改善，子宫体积显著缩小；3例发生轻度宫腔粘连。5例患者均成功妊娠。1例慢性高血压患者在34周时发生重度子痫前期并接受剖宫产，其余4例足月剖宫产分娩。发生3例胎盘植入和2例产后出血。长期随访期间，1例患者产后2年因月经量增多行子宫切除术，其余4例情况稳定。
根据DUL患者的病情进行个体化治疗可保留生育能力，支持成功妊娠并获得良好的妊娠结局。
