背景:子宫坏死是一种罕见的疾病,被认为是危及生命的并发症。然而,子宫坏死的病例很少报道,尤其是那些由感染引起的。在治疗方面,目前尚无微创治疗子宫坏死的报道,全子宫切除术主要被认为是治疗选择。
目的:本文特别关注微创治疗,并对近期子宫坏死病例进行总结。
方法:我们报告了一例28岁的第1妊娠患者,第0段因胎儿死亡引产失败后进行了剖宫产。她出现反复发烧和阴道分泌物。血液炎症标志物升高,CT扫描显示子宫腔内不规则肿块,信号强度低。妇科检查显示存在灰色和白色软组织,大约5厘米长,从子宫颈渗出.分泌物中含有坏死梭杆菌,大肠杆菌,培养后的变形杆菌。鉴于患者感染引起的败血症和子宫坏死,腹腔镜探查在子宫前壁发现白色脓液和坏死组织开口。手术中切除坏死组织,子宫也修复了.术后病理显示梭形细胞样组织完全变性坏死。术后考虑由多药耐药细菌感染引起的严重子宫坏死。她用抗生素治疗了三周,感染得到控制后出院。患者对治疗方案表示满意,保留了她的子宫,维持生殖功能,并尽量减少手术的范围。
结论:基于子宫坏死的文献综述,我们发现它有潜在的死亡风险,强调管理病情进展的重要性。大多数治疗选择涉及全子宫切除术。部分子宫切除术减少了手术的范围,保留生育功能,也可以在子宫坏死的治疗中产生积极的结果,作为对这种情况的整体治疗的补充。
BACKGROUND: Uterine necrosis is a rare condition and is considered a life-threatening complication. However, cases of uterine necrosis were rarely reported, particularly those caused by infection. In terms of treatment, no minimally invasive treatment for uterine necrosis has been reported, and total hysterectomy is mostly considered as the treatment option.
OBJECTIVE: The article specifically focuses on minimally invasive treatments and provides a summary of recent cases of uterine necrosis.
METHODS: We report the
case of a 28-year-old patient gravid 1, para 0 underwent a cesarean section after unsuccessful induction due to fetal death. She presented with recurrent fever and vaginal discharge. The blood inflammation markers were elevated, and a CT scan revealed irregular lumps with low signal intensity in the uterine cavity. The gynecological examination revealed the presence of gray and white soft tissue, approximately 5 cm in length, exuding from the cervix. The secretions were found to contain Fusobacterium necrophorum, Escherichia coli, and Proteus upon culturing. Given the patient\'s sepsis and uterine necrosis caused by infection, laparoscopic exploration uncovered white pus and necrotic tissue openings in the anterior wall of the uterus. The necrotic tissue was removed during the operation, and the uterus was repaired. Postoperative pathological findings revealed complete degeneration and necrosis of fusiform cell-like tissue. Severe uterine necrosis caused by a multi-drug resistant bacterial infection was considered after the operation. She was treated with antibiotics for three weeks and was discharged after the infection was brought under control. The patient expressed satisfaction with the treatment plan, which preserved her uterus, maintained reproductive function, and minimized the extent of surgery.
CONCLUSIONS: Based on the literature review of uterine necrosis, we found that it presents a potential risk of death, emphasizing the importance of managing the progression of the condition. Most treatment options involve a total hysterectomy. A partial hysterectomy reduces the extent of the operation, preserves fertility function, and can also yield positive outcomes in the treatment of uterine necrosis, serving as a complement to the overall treatment of this condition.