妊娠中の子宮筋腫核出術：意思決定と転帰-2症例の報告

Uterine fibroids are common benign smooth muscle tumours that may complicate pregnancy with pain and pressure symptoms. While conservative management is preferred due to the risk of haemorrhage and pregnancy loss, antepartum myomectomy may be indicated in selected cases with intractable symptoms.

We report 2 cases of successful antepartum myomectomy performed in the second trimester for severe, unrelenting pain secondary to large fibroids. The first case involved a 27-year-old primigravida at 15 + 2 weeks' gestation with a 22 × 16 × 17 cm pedunculated fibroid causing respiratory compromise. The second case involved a 41-year-old multigravida at 14 weeks' gestation with multiple fibroids, the largest measuring 19 × 21 cm. Both patients underwent open myomectomy following multidisciplinary evaluation and counselling. Estimated blood loss was minimal, and postoperative recovery was uneventful. Pregnancies progressed to term, resulting in favourable maternal and fotal outcomes.

Antepartum myomectomy, though rarely indicated, can be safely performed in well-counselled, carefully selected patients with severe symptoms and favourable fibroid characteristics. Preoperative imaging, multidisciplinary planning and meticulous surgical technique are crucial for optimal outcomes.