产后子宫肌瘤剔除术后早期炎性肠梗阻一例

doi:10.12280/gjszjk.20210324

摘要/Abstract

摘要：

子宫肌瘤是育龄女性最常见的生殖系统良性肿瘤。妊娠合并子宫肌瘤是常见的妊娠合并症,属于产科高危妊娠的范畴。目前对于妊娠合并子宫肌瘤的管理仍存在一些争议。报告近期广州中医药大学第一附属医院妇科收治的1例妊娠合并肌壁间子宫肌瘤患者自然分娩后子宫肌瘤红色变性并发产褥感染,经腹式子宫肌瘤剔除术剔除病灶,同时并发术后早期炎性肠梗阻的病例诊治情况。手术病理证实为子宫平滑肌瘤伴红色变性及坏死,慢性化脓性子宫内膜炎;术中宫腔分泌物细菌培养结果为苛养颗粒链菌（Granulicatella elegans）。同时探讨子宫肌瘤妊娠前及妊娠期管理、妊娠合并子宫肌瘤红色变性及产褥期并发症如产褥感染、产后出血的处理策略,以及术后早期炎性肠梗阻的预防措施和诊治方案。

关键词: 妊娠, 子宫, 肌瘤, 产褥期感染, 肠梗阻, 病例报告

Abstract:

Uterine fibroid is the most common benign tumors of female reproduction system of reproductive age. Pregnancy combined with hysteromyoma is a common pregnancy complication, which belongs to the category of high risk pregnancy. There are still some disputes about the management of pregnancy complicated with hysteromyoma. A complex case of postpartum uterine fibroid with red degeneration and puerperal infection after abdominal myomectomy, and combined with early postoperative inflammatory small bowel obstruction, was reported. Pathological diagnosis showed the hysteromyoma with red degeneration and necrosis, chronic suppurative endometritis. The culture of uterine secretions suggested the infection with Granulicatella elegans. Combined with this case report, we also review the management of hysteromyoma during prenatal and gestation period, the treatment strategies of pregnancy complicated with red degeneration of hysteromyoma and puerperal complications such as puerperal infection and postpartum hemorrhage, as well as the preventive measures, diagnosis and treatment of early postoperative inflammatory small bowel obstruction.

Key words: Pregnancy, Uterus, Myoma, Puerperal infection, Intestinal obstruction, Case reports

陈燕芬, 卢如玲, 郑聪聪, 曾蕾, 刘冠彤, 谢琳玲, 曾宇华. 产后子宫肌瘤剔除术后早期炎性肠梗阻一例[J]. 国际生殖健康/计划生育, 2022, 41(1): 25-29.

CHEN Yan-fen, LU Ru-ling, ZHENG Cong-cong, ZENG Lei, LIU Guan-tong, XIE Lin-ling, ZENG Yu-hua. A Case Report of Early Inflammatory Intestinal Obstruction after Postpartum Myomectomy[J]. Journal of International Reproductive Health/Family Planning, 2022, 41(1): 25-29.

图/表 7

图1 盆腔MRI图注：提示子宫后壁近宫底区占位病变伴低强化。

图2 宫底肿物术中所见图注：宫底见一大小约8 cm×8 cm×5 cm肿物突出。

图3 肌壁间子宫肌瘤术中所见图注：肿物为旋涡状结构,内含脓性分泌物。

图4 宫腔底部赘生物术中所见图注：宫腔见黄染赘生物。

图5 术后腹部平片图注：不完全性肠梗阻。

图6 复查腹部平片图注：肠管积气扩张减轻。

表1 治疗前后感染指标变化情况

感染指标	2021-02-20 产科入院	2021-03-06 妇科入院	2021-03-12 术后复查	2021-03-16 术后肠梗阻	2021-03-27 肠梗阻缓解
白细胞计数（×10⁹/L）	7.09	12.43	13.26	14.97	6.37
中性粒细胞	0.71	0.73	0.87	0.79	0.57
C反应蛋白（mg/L）	50.60	18.58	87.90	152.00	27.80
降钙素原（ng/mL）	0.17	<0.05	0.09	1.05	0.48

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