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Abstract: The vast majority of fibroids are uterine smooth muscle tumors, which are one of the common benign tumors in gynecology and have a relatively high clinical incidence. This female patient, 45 years old, visited our hospital for uterine smooth muscle tumor. Before hospitalization, she was anemic due to increased menstrual flow. After hospitalization, she underwent aggressive preoperative preparation and laparoscopic myomectomy under epidural anesthesia, and the patient was discharged after surgery.
Basic information】Female, 45 years old
Disease Type】Uterine smooth muscle tumor
Hospital】Guangzhou Huadu District People’s Hospital
Date of consultation】December 2019
Treatment plan】Surgical treatment (uterine myomectomy) + intravenous infusion (5% glucose injection + compound sodium chloride injection + compound amino acid injection (18AA) + 0.9% sodium chloride injection + cefuroxime sodium for injection) + oral medication (ferrous sulfate slow-release tablets)
[Treatment cycle] 10 days of inpatient treatment, 1 month of outpatient review, 2 months of follow-up
Treatment effect】Menstrual flow returned to normal and the disease was controlled
I. Initial consultation
The patient is a 45-year-old woman who came to our hospital for six months with shortened menstrual cycle, prolonged menstruation and increased menstrual flow. She usually has heavy menstrual flow with blood clots, and her menstrual cycle is usually 30 days/time, but in the past 6 months, her menstrual cycle is 23-26 days/time, and she has had dizziness and panic attacks in the past 2 months due to increased menstrual flow. The patient indicated that she had uterine fibroids in the past and had not had a follow-up examination in the past 1 year.
General condition was good, slightly pale face, normal development, no abnormal heart and lung auscultation, abdomen was flat and soft, enlarged uterus could be palpated on the pubic symphysis, no obvious pressure pain. Gynecologic examination: vulva was married in transitional style, vagina was unobstructed, cervical hypertrophy, uterus was anteriorly positioned, significantly enlarged, 9×8×8 cm in size, uneven surface, hard texture, no abnormal masses were palpated in bilateral adnexal areas. Color vaginal ultrasonography: the uterus was anteriorly enlarged, with abnormal morphology and heterogeneous echogenicity of the muscular layer. A type of round hypoechoic mass was seen in the anterior wall muscular layer, mostly projecting toward the plasma layer, about 58×43×49 mm, with non-uniform echogenicity in the still-clear border.
II. Treatment history
Since the patient had fertility requirements, she decided to undergo laparoscopic resection of uterine fibroids under comprehensive consideration, so she actively improved the preoperative examination and prepared for blood and fluid transfusion. injection, compound sodium chloride injection, compound amino acid injection (18AA), and 0.9% sodium chloride injection. The amount of rehydration fluids was reduced until after exhaustion, while cefuroxime sodium for injection was added to prevent infection treatment, and oral ferrous sulfate extended-release tablets were started on the third postoperative day to correct anemia treatment.
III. Treatment effect
Uterine fibroids of 6×5×5cm in size were removed during surgery, and the pathological laboratory results were uterine smooth muscle tumor. After surgery, the patient was discharged from the hospital after 48 hours with normal gastrointestinal peristalsis and good wound healing. The patient was in good condition and had a normal diet. One month after the operation, the abdominal color ultrasound was repeated and showed that the uterus returned to normal size. After 2 months of follow-up, the patient’s menstrual flow returned to normal, and the menstrual period was usually maintained for 5-6 days, with a menstrual cycle of 28-30 days/time.
IV. Notes
We are glad that the patient’s condition has improved, but since uterine smooth muscle tumors are recurrent, patients are advised to follow medical advice for regular ultrasound examinations. Avoid soy milk, onion and black beans in daily diet, enhance nutrition, eat more blood-supplementing foods such as pork liver, lean meat, red dates and black chicken, and continue to take oral ferrous sulfate slow-release tablets to correct anemia.
In addition, attention needs to be paid to contraception, pregnancy is not recommended for 2 years, and an ultrasound examination is needed to understand the thickness of the uterine scar before planning a pregnancy in the future.
V. Personal insight
Although uterine smooth muscle tumor is a benign gynecological tumor, 1% of patients may develop malignant lesions. Therefore, once the uterine smooth muscle tumor is detected, regular gynecological examination should be done without the indication of surgery, and once the myoma exceeds 5 cm, surgery should be performed as soon as possible.
In this case, the uterine smooth muscle tumor was relatively large, but no malignant lesion occurred. Although most of the fibroids were convex to the plasma membrane layer, some of them were convex to the uterine cavity and also caused serious clinical symptoms. Since the patient had fertility requirements, the uterus was preserved, but regular review was required.