經子宮鏡進行子宮黏膜下巨大肌瘤切除術後成功妊娠分娩的個案報告

A Case Report of Pregnancy and Delivery after Large Submucosal Myoma Successfully Removed by Single-Session Hysteroscopic Myomectomy

本文為探討一位31歲不孕女性接受子宮黏膜下肌瘤切除手術後懷孕產子病例。此位婦女初到婦產科門診表示她的月經不規律，出血量很大。透過超音波檢查影像顯示子宮黏膜下有巨大的肌瘤，大小為6.2×4.6 cm2，在門診先給予黃體素受體抑制劑抑制月經縮減肌瘤體積後，出血狀況獲得些微改善之後，在子宮鏡下切除肌瘤後經陰道將多塊肌瘤組織取出，最大尺寸達4.9×3.5×1.8 cm3，重達47公克，術後治療狀況良好後，月經週期變為正常且無異常出血，然而ㄧ直無法順利懷孕，嘗試在其排卵後給予低劑量黃體素治療一直無法順利懷孕，直至調整到高劑量黃體素為800mg/day時成功受孕著床，在懷孕四十周齡時順利生產一健康男嬰。我們介紹了一個有月經異常出血症狀的子宮黏膜下肌瘤的病例，子宮肌瘤切除術成功治療，術後順利懷孕生產。

This article discusses the case of pregnancy and childbirth in a 31-year-old non-pregnant woman who underwent submucosal myomectomy. She visited the obstetrics and gynecology clinic, reporting irregular menstruation and heavy bleeding. Ultrasound images revealed submucosal fibroids of the uterus, measuring 6.2×4.6 cm². Bleeding slightly improved after the administration of the progesterone receptor inhibitor (Ulipristal) and hemostatic agent (Tranexamic acid). She underwent hysteroscopic myomectomy to remove submucosal fibroids, consisting of multiple pieces of gray-white soft tissue, with the largest size measuring 4.9×3.5×1.8 cm3 and a weight of 47 grams. Postoperatively, she was in good condition with normal menstruation. Following successful pregnancy, she received high-dose progesterone therapy after ovulation. At 40 weeks pregnant, she visited the obstetrics and gynecology department due to lower abdominal pain and successfully gave birth to a healthy baby boy. This case presents symptomatic uterine submucosal fibroids diagnosed before pregnancy, successfully treated with myomectomy, resulting in a successful pregnancy and delivery.