Zhang HL, Yu SY, Cao CW, Zhu JE, Li JX, Sun LP, Xu HX. Uterine artery embolization combined with percutaneous microwave ablation for the treatment of prolapsed uterine submucosal leiomyoma: A case report. World J Clin Cases 2023; 11(13): 3052-3061 [PMID: 37215407 DOI: 10.12998/wjcc.v11.i13.3052]
Corresponding Author of This Article
Hui-Xiong Xu, PhD, Professor, Department of Ultrasound, Zhongshan Hospital, No. 180 Fenglin Road, Xu Hui District, Shanghai 200032, China. xuhuixiong2022@126.com
Research Domain of This Article
Obstetrics & Gynecology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Hui-Li Zhang, Song-Yuan Yu, Jing-E Zhu, Jia-Xin Li, Li-Ping Sun, Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People’s Hospital, Shanghai 200072, China
Chuan-Wu Cao, Department of Interventional and Vascular Surgery, Shanghai Tenth People’s Hospital, Shanghai 200072, China
Hui-Xiong Xu, Department of Ultrasound, Zhongshan Hospital, Shanghai 200032, China
Author contributions: Zhang HL contributed to manuscript writing and editing and data collection; Cao CW and Yu SY contributed to session one and session two of the treatment procedure; Li JX, Zhu JE, and Sun LP contributed to the evaluation and treatment of the patient; Xu HX contributed to the conceptualization and supervision of the study; all authors have read and approved the final manuscript.
Supported byScience and Technology Commission of Shanghai Municipality, China, No. 19DZ2251100; Shanghai Municipal Health Commission, China, No. SHSLCZDZK 03502; National Natural Science Foundation of China, No. 81725008.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hui-Xiong Xu, PhD, Professor, Department of Ultrasound, Zhongshan Hospital, No. 180 Fenglin Road, Xu Hui District, Shanghai 200032, China. xuhuixiong2022@126.com
Received: December 3, 2022 Peer-review started: December 3, 2022 First decision: February 17, 2023 Revised: February 24, 2023 Accepted: March 31, 2023 Article in press: March 31, 2023 Published online: May 6, 2023 Processing time: 142 Days and 22 Hours
Abstract
BACKGROUND
Vaginal myomectomy is the most common form of radical treatment for prolapsed submucosal leiomyoma and is typically performed under general anesthesia. However, an alternative treatment approach is needed for patients who cannot tolerate general anesthesia. We describe a case with such a patient who was successfully treated via a minimally invasive method under local anesthesia.
CASE SUMMARY
A 46-year-old female suffered from abnormal uterine bleeding, severe anemia, and a reduced quality of life attributed to a massive prolapsed submucosal leiomyoma. She could not tolerate general anesthesia due to a congenital thoracic malformation and cardiopulmonary insufficiency. A new individualized combined treatment, consisting uterine artery embolization (UAE), percutaneous microwave ablation (PMWA) of the pedicle and the endometrium, and transvaginal removal of the leiomyoma by twisting, was performed. The lesion was completely removed successfully under local anesthesia without any major complications. The postoperative follow-up showed complete symptom relief and a significant improvement in the quality of life.
CONCLUSION
UAE combined with PMWA can be performed under local anesthesia and is a promising alternative treatment for patients who cannot tolerate general anesthesia.
Core Tip: Uterine leiomyoma is a clinically common and benign tumor. The mainstream treatment for prolapsed leiomyoma is myomectomy. General anesthesia is usually needed when resecting large lesions. However, for patients with severe systematic disease who cannot tolerate general anesthesia, radical treatment is not feasible. We report a patient who was treated successfully via a minimally invasive method under local anesthesia. A large prolapsed leiomyoma was removed after a combination of uterine artery embolism and percutaneous microwave ablation treatment. This is a good example of the use of minimally invasive interventional technology for treating special patients.
