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題名 | Successful Pregnancy after Treatment of Deep adenomyosis with Cytoreductive Surgery and Subsequent Gonadotropin-Releasing Hormone Agonist: A Case Report=併用減積手術及GnRHa治療嚴重性子宮肌腺瘤致妊娠成功: 一病例報告 |
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作者 | 黃文賢; 楊再興; 袁九重; | 書刊名 | 中華醫學雜誌 |
卷期 | 61:12 1998.12[民87.12] |
頁次 | 頁726-729 |
分類號 | 417.281 |
關鍵詞 | 子宮肌腺瘤; 減積手術; 妊娠; Adenomyosis; Cytoreductive surgery; Pregnancy; |
語文 | 英文(English) |
中文摘要 | 子宮肌腺瘤是一種相當常見的病理表現而且與婦女的月經特質及生育能力密切相 關。它雖偶發於年輕婦女,但其主要的症狀仍以年齡35歲以上者居多。對於具有強烈意願 、極力想保有再生育能力以尋求成功妊娠的患者而言,現今尚無一致之處理原則。本篇文章 報告1例因嚴重性子宮肌腺瘤致長期繼發性不孕婦女,在接受併用減積手術及術後6個月療 程之 GnRHa 治療後成功妊娠之病例。 對極力想保有再生育能力的婦女,基於子宮肌腺瘤有 復發傾向和減積手術術後子宮肌肉層多遭破壞之雙重考慮,我們建議凡接受減積手術者術後 應盡早接受 GnRHa 治療。同時,也應等待術後4至6個月才試行懷孕。 本例在整個懷孕過 程中,有關產科的主要併發症,如子宮收縮無力、子宮破裂和嵌入性胎盤並未發生,雖然患 者兩度出現先兆性流產以及一次早產現象,先前又曾經接受過減積手術,但患者仍在接受剖 腹生產之後順利產下一名重達 2,900 公克之健康女嬰。有別於單純使用 GnRHa 內科治療子 宮肌腺瘤婦女,在此,本篇文章提出併用減積手術及 GnRHa 治療是妊娠成功的新選擇。 |
英文摘要 | Adenomyosis is a common pathologic finding significantly related to the menstrual and reproductive characteristics of women. Although noted during younger reproductive years, it usually presents in women over 35 years of age. For those with a strong desire to preserve fertility, there is presently no uniform agreement on the most appropriate therapeutic methods to manage the condition. Herein, we present a case of long-term secondary infertility with successful pregnancy after treatment of deep adenomyosis with cytoreductive surgery and a subsequent six-month course of gonadotropin-releasing hormone agonist (GnRHa) therapy. For those who want to conceive, early combined GnRHa therapy immediately following cytoreductive surgery and a delay of four to six months before attempting to fall pregnant is advisable. This is because adenomyosis tends to recur rapidly and the myometrium can be significantly disrupted during surgery. The major obstetric complications, such as uterine atony, rupture or placenta accreta, do not increase with adenomyosis during pregnancy. Although two events of threatened abortion and one of preterm labor were encountered during the pregnancy course, a healthy 2,900-g female was delivered by low transverse cesarean section at term. A cesarean section was performed because of previous large cytoreductive surgery. In contrast to GnRHa therapy alone, we report an effective alternative to hysterectomy in order to maintain fertility and achieve successful pregnancy. |
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