Is cesarean myomectomy in patients with large multiple myomas always a hazardous procedure? A case report (Running title: Cesarean myomectomy in the treatment of large multiple myomas)
Miomektomija u toku carskog reza kod pacijentkinja sa velikim multiplim miomima - koliki je rizik? Prikaz slučaja

Radmila Sparić, Milan Dokić, Ivana Likić-Lađević, Dragiša Šljivančanin, Milica Stojičić, Snežana Vidaković
2018 Serbian Journal of Anesthesia and Intensive Therapy  
Sažetak Uvod:Veliki i multipli miomi su dobro poznat uzrok infertiliteta, ali nije neuobičajeno da i pored njihovog prisustva dođe do spontane trudnoće. Tretman pacijentkinja sa velikim i multiplim miomima je kontroverzan, ne samo u toku trudnoće već i prilikom porođaja. Ovakvi miomi mogu da budu uzrok značajnog morbiditeta u puerperijumu. Carski rez je najčešći način završavanja porođaja. Prikaz slučaja: Carski rez sa polimiomektomijom učinjen je u 36. nedelji gestacije, kod pacijentkinje sa
more » ... pacijentkinje sa velikim multiplim miomima, uz upotrebu cell savera, sa dobrim fetalnim i maternalnim ishodom. Pristup donjem segmentu uterusa je bio moguć uprkos postojanju velikih mioma. Živo novorođenče, telesne mase 2600 grama, rođeno je bez teškoća. Nakon zbrinjavanja histerotomije, učinjena je ekstrakcije najvećeg mioma (210 × 180 ×155 mm) i njegovo ležište je ušiveno u dva sloja. U toku miomektomije, korišćen je cell-saver i spasena je značajna količina krvi. Pošto je ustanovljena adekvatna hemostaza, odlučeno je da se ukloni i preostalih osam mioma, što je i učinjeno, bez otvaranja materične duplje. Zaključak: Mali je broj radova koji prikazuju intraoperativno "spasavanje krvi" kao tehniku kojom se rešava intraoperativno krvarenje u toku miomektomije, tokom carskog reza. Naš slučaj dokazuje da intraoperativno "spasavanje krvi" u kombinaciji sa velikim hirurškim iskustvom u klasičnoj miomektomiji značajno poboljšava ishod ovakvih operacija. Summary Introduction: Although large multiple myomas are a well-known cause of infertility, it is not uncommon to encounter pregnancy with such myomas. Management of women with large multiple myomas is controversial, both during pregnancy and delivery. Such myomas can also cause significant morbidity during the puerperium. Caesarean section is the most common way of delivery. Case report: A patient with large multiple myomas underwent a cesarean myomectomy with intraoperative cell salvage at 36 weeks of gestation. Both fetal and maternal outcomes were favorable. The lower uterine segment was accessible, despite the presence of myomas, and a live fetus weighing 2600 g was delivered without difficulties. Following a hysterotomy suturing, the largest myoma (210 × 180 × 155 mm) was removed and the myoma bed was sutured in two layers. Cell-saver was introduced during myomectomy saving significant amount of blood. Careful inspection confirmed appropriate hemostasis, so it was decided to remove the remaining eight myomas, and this was done without breaching the uterine cavity. Conclusion: There are few literature reports on intraoperative cell salvage as a technique of handling intraoperative hemorrhage during a CM. As documented by our case, the use of intraoperative cell salvage represents a significant advantage in such cases when combined with extensive surgical experience in conventional myomectomy.
doi:10.5937/sjait1808171s fatcat:wltu25khprh3lc5ca2v7vkfyzq