經子宮動脈栓塞術及腹腔鏡全子宮切除治療的巨大左側漿膜下子宮肌瘤的案例報告

A Case of Massive Left-sided Subserosal Uterine Myoma Treated with uterine Artery Embolization and Total Laparoscopic Hysterectomy

本文為探討一位生產史為懷孕1次、生產1次的47歲女性因左側有一巨大漿膜下肌瘤（subserosal myoma）併發排尿困難已經一年多。因無法馬上接受開刀，先經子宮動脈栓塞術做處理後出院，在症狀改善後，一年後又因排尿困難無法完全排除且發生嚴重便秘的症狀而再次就醫，最終接受子宮全切除手術的治療。此位婦女初到婦產科門診表示她排尿困難，經陰道超音波檢查影像顯示子宮左側有巨大的漿膜下肌瘤，大小為11.3 cm×7.3 cm，即建議以子宮肌瘤摘除術進行切除，但是病人拒絕，因此改以子宮動脈栓塞術進行子宮肌瘤的治療方式。在X光透視及血管攝影導引下，使用導管經由鼠蹊部進入雙側內髂動脈，導入雙側子宮動脈內將2 ml微小的栓塞劑顆粒注入供應子宮肌瘤的動脈中。患者於血管栓塞治療後順利出院，排尿症狀緩解。但一年之後，因為嚴重便秘問題再次來到門診，經陰道超音波檢查影像顯示仍存在的左側漿膜下子宮肌瘤，其大小為9.4 cm×6.5 cm，病人因症狀已無法忍受，立即住院並接受腹腔鏡子宮全切除術的治療，術後無任何併發症，從此恢復健康生活。

This article discusses the case of a 47-year-old woman with a history of one pregnancy and one delivery (G1P1–gravidity 1 and parity 1), who experienced difficulty urinating for over a year due to a massive left-sided subserosal uterine myoma (also known as uterine leiomyoma or uterine fibroid). As she could not undergo surgery immediately, she first received treatment through uterine artery embolization to improve her condition before being discharged. After experiencing symptom improvement, she returned a year later due to persistent difficulty urinating and severe constipation. Ultimately, she underwent a total laparoscopic hysterectomy for treatment. Upon her initial visit to the obstetrics and gynecology clinic, she reported difficulty urinating. A transvaginal ultrasound revealed a large subserosal uterine myoma on the left side of the uterus, measuring 11.3 cm x 7.3 cm. The recommended treatment was a myomectomy to remove the uterine myoma, but the patient declined. Therefore, uterine artery embolization was chosen as an alternative treatment method. Using fluoroscopy and guided angiography, a catheter was inserted through the inguinal region into both bilateral internal iliac arteries. Then, 2 ml of tiny embolic particles were injected into the arteries supplying the uterine myoma. Following the vascular embolization treatment, the patient was discharged successfully with relieved urinary symptoms. However, a year later, she returned to the clinic due to severe constipation. A transvaginal ultrasound revealed the presence of a remaining left-sided subserosal uterine myoma, measuring 9.4 cm x 6.5 cm. Unable to tolerate the symptoms any longer, she was immediately admitted and underwent a total laparoscopic hysterectomy. There were no complications postoperatively, and she regained a healthy and active lifestyle.