产后子宫脓性肌瘤2例并文献复习  

Postpartum pyomyoma: two cases report and literature review

作　　者：贾芃[1] 杨慧霞[1] 张岩[1] Jia Peng;Yang Huixia;Zhang Yan(Department of Obstetrics and Gynecology,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院妇产科,北京100034

出　　处：《中华围产医学杂志》2022年第3期201-204,共4页Chinese Journal of Perinatal Medicine

摘　　要：目的探讨产后子宫脓性肌瘤的临床特点。方法分析2019年至2020年北京大学第一医院妇产科收治的2例产后子宫脓性肌瘤患者的临床病例资料, 并回顾2000年至2020年国内外报道的16例产后子宫脓性肌瘤病例, 对这18例进行总结分析。结果 18例患者中, 12/15为初产妇(3例未报告孕产史), 孕期子宫肌瘤最大径线[M(min~max)]为10 cm(6~25 cm);12/18有宫腔操作史, 10/18伴有贫血或严重产后出血, 4/18合并其他感染。18例均以发热为首发表现, 伴有腹痛, 14/18发生在产后2周内。CT、MRI和超声的诊断阳性率分别为11/13、3/6和1/8。脓培养阳性率最高, 最常见的感染病原体是大肠杆菌。18例均未死亡, 但其中14例发生严重并发症(脓毒症、脓毒性休克、弥散性血管内凝血、脓肌瘤破裂、腹膜炎及切口感染等)。18例单纯药物抗感染治疗均无效, 均行手术治疗, 术后感染迅速得到控制。3例患者于术后2年(16个月~2年)再次妊娠。结论对于妊娠合并子宫大肌瘤, 尤其合并贫血、感染或有宫腔操作史, 且产后发热者, 要警惕子宫脓性肌瘤。子宫脓性肌瘤一经明确诊断, 应尽早手术治疗。Objective:To investigate the clinical characteristics of postpartum pyomyoma.Methods:Clinical data of two patients with postpartum pyomyoma admitted to the Department of Obstetrics and Gynecology,Peking University First Hospital,between 2019 and 2020,were collected.Another 16 postpartum pyomyoma reported in China and foreign areas from 2000 to 2020 were reviewed.Results:Apart from three patients without reported gravidity and parity,12 out of the remaining 15 patients were primiparous.The median maximum diameter of uterine fibroids in pregnancy was 10 cm(6-25 cm).Of the 18 patients,12 had a history of intrauterine manipulation,10 had anemia or severe postpartum hemorrhage,and four had other infections.All patients manifested as fever at first,and most were accompanied by abdominal pain.The onset time of 14 cases was within postpartum two weeks.CT,MRI,and ultrasound detection rate in diagnosing postpartum pyomyoma was 11/13,3/6,and 1/8,respectively.Pus culture had the highest positive rate,with Escherichia coli as the most common pathogen.No death was reported,but 14 patients developed severe complications,including sepsis,septic shock,disseminated intravascular coagulation,rupture of pyomyoma,peritonitis,and incision infection.As failing in anti-infection medication,all patients received surgical treatment,which controlled infections.Three patients were conceived two years after the operation(16 months to two years).Conclusions:Pyomyoma should be considered once postpartum fever develops in patients complicated by uterine fibroids≥10 cm in diameter during pregnancy,especially those with anemia,infection,or a history of intrauterine manipulation.Surgical treatment should be performed once pyomyoma is diagnosed.

关 键 词：子宫肿瘤 平滑肌瘤 妊娠并发症 肿瘤 产后期 宫腔积脓 

分 类 号：R737.33[医药卫生—肿瘤]