妊娠合并巨大子宫肌瘤行剖宫产同时剔除巨大肌瘤1例

One Case of Cesarean Section with Removal of a Huge Uterine Fibroid in a Pregnant Woman with a Huge Uterine Fibroid

摘要: 目的：探讨妊娠合并巨大子宫肌瘤的临床诊疗策略及剖宫产同期行子宫肌瘤剔除术的安全性与操作要点。方法：回顾分析暨南大学附属第一医院2025年8月收治的1例妊娠合并巨大子宫肌瘤行剖宫产同期肌瘤剔除术患者的临床资料，并结合相关文献进行分析。结果：该患者为35岁高龄初产妇，孕36 + 5周因早产临产入院，孕期肌瘤进行性增大至176 mm × 164 mm × 169 mm，经多学科会诊后行急诊剖宫产 + 右侧宫底部巨大肌瘤剔除术，术中采取综合止血措施，术后出现感染及伤口脂肪液化，经精准抗感染、伤口对症处理后痊愈出院；病理提示子宫平滑肌瘤伴红色样变，局灶细胞增生较活跃。结论：妊娠合并巨大子宫肌瘤为高危妊娠，孕期需密切监测肌瘤及胎儿情况；剖宫产同期行肌瘤剔除术虽存在出血、感染等风险，但经术前多学科评估、术中精准止血、术后个体化并发症管理，该术式安全可行，可避免患者二次手术创伤，临床需根据肌瘤特征、患者意愿及医院救治能力制定个体化方案。

Abstract: Objective: To investigate the clinical diagnosis and treatment strategies for pregnancy complicated by giant uterine fibroids, as well as the safety and technical key points of concurrent myomectomy during cesarean section. Methods: The clinical data of one patient with pregnancy complicated with giant uterine leiomyoma who underwent simultaneous myomectomy during cesarean section and was admitted to the First Affiliated Hospital of Jinan University in August 2025 were retrospectively analyzed, combined with a review of relevant literature. Results: The patient was a 35-year-old elderly primipara who was admitted to hospital due to preterm labor at 36 + 5 weeks of gestation. The uterine leiomyoma grew progressively to 176 mm × 164 mm × 169 mm during pregnancy. After multidisciplinary consultation, emergency cesarean section combined with myomectomy for the giant leiomyoma at the right uterine fundus was performed, and comprehensive hemostatic measures were adopted during the operation. Postoperatively, the patient developed infection and wound fat liquefaction, and was discharged from hospital after recovery following targeted anti-infection therapy and symptomatic wound management. Pathological examination indicated uterine leiomyoma with red degeneration and focal active cellular proliferation. Conclusion: Pregnancy complicated with giant uterine leiomyoma is a high-risk pregnancy, requiring close monitoring of the leiomyoma and fetal status during pregnancy. Although simultaneous myomectomy during cesarean section carries risks such as hemorrhage and infection, the procedure is safe and feasible with preoperative multidisciplinary evaluation, precise hemostasis during the operation and individualized management of postoperative complications, which can avoid secondary surgical trauma for patients. Individualized clinical protocols should be formulated based on the characteristics of the leiomyoma, the patient’s wishes and the hospital’s treatment capacity.