子宫肌瘤自发性破裂出血致失血性休克1例并文献复习

A Case of Hemorrhagic Shock Due to Spontaneous Rupture and Bleeding of Uterine Fibroids and Literature Review

摘要: 子宫肌瘤是女性生殖系统中最常见的良性肿瘤，发病率约为4.5%~68.6%，近期有研究证实其发病率甚至高达70%~80%。约30%的子宫肌瘤患者可出现临床症状，主要包括异常子宫出血、周围器官压迫症状、盆腔疼痛、不孕及产科并发症等。子宫肌瘤的急性并发症很少见，包括有肌瘤蒂扭转、变性和破裂出血，而子宫肌瘤自发性破裂引起腹腔内出血是一种非常罕见的表现。大多数发生在育龄妇女中，患者突然出现严重腹痛和严重低血容量休克，需要紧急手术干预。尽管医学影像技术不断进步，但术前诊断仍常被漏诊。在此，本文报道了一例子宫肌瘤自发性破裂出血导致休克的患者，并探讨其诊断和治疗策略，旨在为临床诊断和治疗提供参考。

Abstract: Uterine fibroids are the most common benign tumours in the female reproductive system, with a prevalence of about 4.5~68.6 percent, and recent studies have confirmed that their prevalence is even as high as 70~80 percent. About 30% of patients with uterine fibroids may present clinical symptoms, mainly including abnormal uterine bleeding, symptoms of peripheral organ compression, pelvic pain, infertility and obstetric complications. Acute complications of fibroids are rare and include fibroid tip torsion, degeneration and rupture and bleeding, while spontaneous rupture of fibroids causing intra-abdominal haemorrhage is a very rare presentation. Mostly it occurs in women of childbearing age, where the patient presents suddenly with severe abdominal pain and severe hypovolaemic shock, requiring urgent surgical intervention. Despite advances in medical imaging technology, preoperative diagnosis is still often missed. Herein, we report a case of spontaneous rupture of uterine fibroid with bleeding leading to shock and discuss the diagnostic and therapeutic strategies, aiming to provide reference for clinical diagnosis and treatment.