Objective

To review causes of pelvic pain among adolescents and discuss surgical techniques for safe and effective resection of juvenile cystic adenomyomas.

Design

Case report.

Setting

Academic medical center.

Patients

We present a 16-year-old patient with chronic pelvic pain and ultrasound evidence of a 2.4 cm adenomyoma. The lesion was thought specifically to represent a juvenile cystic adenomyoma, defined as a cystic lesion >1 cm occurring in women younger than 30 years with severe dysmenorrhea that is distinct from the uterine cavity and surrounded by hypertrophic myometrium.

Intervention

Given minimal relief from medical therapy and high suspicion for coexistent endometriosis, our patient elected to undergo laparoscopic resection of adenomyoma and excision of pelvic lesions.

Main Outcome Measures

Preoperative considerations discussed in this video include imaging to identify the location of the lesion and adjacent structures, such as the uterine vessels, discontinuation of gonadotropin-releasing hormone agonist for adequate intraoperative visualization, and the high likelihood of encountering endometriosis at operation.

Results

We review the following surgical techniques: maximize visualization with the use of a uterine manipulator and temporary oophoropexy, optimize hemostasis via temporary uterine artery ligation and control of collateral blood vessels, complete ureterolysis, meticulous enucleation of adenomyoma, and excision of coexistent endometriotic lesions. Surgical findings demonstrated a 2 cm lesion along the left lower uterine segment and red-brown lesions along bilateral ovarian fossa, pathologically confirmed as adenomyoma and superficial endometriosis, respectively.

Conclusion

This video presents strategies for safe and effective adenomyoma resection and treatment of refractory chronic pelvic pain in an adolescent.

中文翻译：

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幼年囊性腺肌瘤切除的手术技术

客观的

回顾青少年盆腔疼痛的原因，并讨论安全有效切除幼年囊性腺肌瘤的手术技术。

设计

案例报告。

环境

学术医疗中心。

病人

我们介绍了一名患有慢性盆腔疼痛和 2.4 厘米腺肌瘤超声证据的 16 岁患者。该病变被认为特别代表了幼年囊性腺肌瘤，定义为大于 1 cm 的囊性病变发生在 30 岁以下患有严重痛经的女性身上，该病变与子宫腔不同，并被肥厚的子宫肌层包围。

干涉

鉴于药物治疗的轻微缓解和对共存的子宫内膜异位症的高度怀疑，我们的患者选择接受腹腔镜子宫腺肌瘤切除术和盆腔病变切除术。

主要观察指标

本视频中讨论的术前注意事项包括通过影像学识别病变和邻近结构（例如子宫血管）的位置、停止使用促性腺激素释放激素激动剂以实现充分的术中可视化，以及在手术中极有可能遇到子宫内膜异位症。

结果

我们回顾了以下手术技术：使用子宫操纵器和临时卵巢固定术最大限度地实现可视化，通过临时子宫动脉结扎和控制侧支血管优化止血，完全溶解输尿管，细致的腺肌瘤摘除术，以及切除共存的子宫内膜异位病变。手术结果显示左侧子宫下段有一个 2 cm 的病灶，双侧卵巢窝有红褐色病灶，病理证实分别为子宫腺肌瘤和浅表性子宫内膜异位症。

结论

该视频介绍了安全有效的腺肌瘤切除术和治疗青少年难治性慢性盆腔疼痛的策略。