子宫肌瘤罕见,但可由子宫平滑肌瘤感染引起危及生命的败血症。如果保守治疗失败,最好进行根治性手术以完全清除所有感染灶。但是对于有生育问题的患者,应考虑子宫切除术的替代方法。作者报告了一例产后化脓性肌瘤,以提醒临床医生这种罕见疾病以及需要快速干预以保持患者的生育能力。
一名不明原因发热的产后女性被送往公立医院。病人的一般情况迅速恶化,手术切除化脓性肌瘤被认为是控制感染源的必要条件。病人最初拒绝手术,因为她有生育问题;然而,她出现了感染性休克和急性呼吸窘迫综合征。随后,手术干预被认为是必要的,病人同意做手术.将正常子宫与变性壁内化脓瘤仔细区分,子宫内膜保持完整。在化脓瘤标本中,比维亚普雷沃氏菌,一种内源性厌氧细菌,可以在下生殖道定殖,被检测到。
■对于产后败血症和平滑肌瘤的患者,应考虑化脓瘤,即使患者具有免疫能力且没有危险因素。在亚急性,阴险的进展。
■综合治疗策略,包括感染源控制和子宫保存,是未来生育所必需的。当保守治疗失败时,严格的警惕以及适当和及时的手术干预对于挽救患者和保持生育能力至关重要。
Pyomyoma is rare but can cause life-threatening sepsis from uterine leiomyoma infection. Curative radical surgery to completely remove all infectious foci is preferable if conservative treatment fails, but for patients with fertility concerns, alternatives to uterine removal should be considered. The author reports a case of postpartum
pyomyoma to remind clinicians of this rare disease and the need for rapid intervention to preserve patient fertility.
UNASSIGNED: A postpartum female with a fever of unknown origin was admitted to a public hospital. The patient\'s general condition rapidly worsened, and surgical removal of the
pyomyoma was assumed to be necessary for controlling the infection source. The patient initially refused surgery, as she had fertility concerns; however, she developed septic shock and acute respiratory distress syndrome. Subsequently, surgical intervention was considered imperative, and the patient consented to surgery. Normal uterus was carefully differentiated from degenerated intramural
pyomyoma, and the endometrium remained intact. In the pyomyoma specimen, Prevotella bivia, an endogenous anaerobic bacterium that can colonize the lower genital tract, was detected.
UNASSIGNED: For patients with postpartum sepsis and leiomyoma, pyomyoma should be considered, even if the patient is immunocompetent and has no risk factors.
Pyomyoma can be exacerbated into a fulminant and fatal course after subacute, insidious progression.
UNASSIGNED: Comprehensive treatment strategies, including source control of infection and uterine preservation, are required for future fertility. Strict vigilance and appropriate and prompt surgical intervention when conservative treatments fail are crucial to save the patient and preserve fertility.