Rodriguez B D, Adamson G D
Department of Gynecology and Obstetrics, Stanford University School of Medicine, California.
J Reprod Med. 1993 Jul;38(7):515-20.
Hysteroscopic removal of ectopic bone in the uterus, using laparoscopic control and ultrasonographic confirmation, was used to treat a patient who presented with a diagnosis of osseous metaplasia of the uterus. Pathologic analysis revealed benign bony tissue consistent with a diagnosis of osseous metaplasia. Laparoscopy and hysteroscopy confirmed the presence of bone in the form of spicules perpendicular to the uterine endometrium. Most of the bone was present in the posterior portion of the fundus. Initial removal was performed with biopsy forceps followed by gentle curettage. The resectoscope was then introduced to visualize any remaining spicules and remove them by mechanical means with minimal use of electrosurgery. Transvaginal ultrasound assisted in identifying bone and confirming its removal during and after surgery. The hysteroscopic procedure was viewed laparoscopically to reduce the risk of uterine perforation. Dense right adnexal adhesions were also lysed. The patient received conjugated equine estrogens for five weeks post-operatively. Ultrasound showed an intrauterine pregnancy of 5 to 6 weeks plus two small calcifications approximately 1 mm each. The patient delivered a healthy infant and has had no recurrent problems. This case report demonstrates the successful use of multiple diagnostic and treatment modalities in the treatment of ectopic intrauterine bone.
采用腹腔镜控制和超声确认，经宫腔镜切除子宫内异位骨，用于治疗一名诊断为子宫骨化生的患者。病理分析显示良性骨组织，符合骨化生诊断。腹腔镜检查和宫腔镜检查证实存在垂直于子宫内膜的针状骨。大部分骨位于子宫底部后部。最初用活检钳进行切除，随后轻柔刮宫。然后插入电切镜以观察任何残留的针状骨，并以最少的电外科手术通过机械手段将其去除。经阴道超声辅助在手术期间和术后识别骨并确认其已被切除。通过腹腔镜观察宫腔镜手术以降低子宫穿孔的风险。还松解了右侧附件的致密粘连。患者术后接受了五周的结合马雌激素治疗。超声显示宫内妊娠5至6周加两个小钙化灶，每个约1毫米。患者分娩了一名健康婴儿，且无复发问题。本病例报告证明了多种诊断和治疗方式在治疗子宫内异位骨中的成功应用。
