经脐单孔腹腔镜治疗意外子宫内膜间质肉瘤一例报告

doi:10.3877/cma.j.issn.1674-6899.2020.05.012

中华腔镜外科杂志(电子版) ›› 2020, Vol. 13 ›› Issue (05) : 301 -304. doi: 10.3877/cma.j.issn.1674-6899.2020.05.012

所属专题：经典病例；经典病例；文献；

病例报告

经脐单孔腹腔镜治疗意外子宫内膜间质肉瘤一例报告

王亚雯¹, 郑莹¹^,^†(

)

^1. 610041　成都，四川大学华西第二医院妇科；610041　成都，四川大学华西第二医院出生缺陷与相关妇儿疾病教育部重点实验室

收稿日期:2020-08-17 出版日期:2020-10-30
通信作者: 郑莹
基金资助:
成都市科技局技术创新研发项目(2019-YF05-00473-SN)

Transumbilical laparoendoscopic single-site surgery treatment of an accidental endometrial stromal sarcoma: a case report

Yawen Wang¹, Ying Zheng¹^,^†()

^1. Department of Obstetrics and Gynecology, Sichuan University, Chengdu 610041, China; West China Second Hospital, Birth Defects and Related Mather and Child Diseases Ministry of Education Key Laboratory, Sichuan University, Chengdu 610041, China

Received:2020-08-17 Published:2020-10-30
Corresponding author: Ying Zheng
About author:
Corresponding author: Zheng Ying, Email: zhy_chd@126.com

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目的

总结经脐单孔腹腔镜手术(transumbilical laparoendoscopic single-site surgery, TU-LESS)治疗意外子宫内膜间质肉瘤(endometrial stromal sarcoma，ESS)的技术体会，探讨其在治疗此类疾病中的安全性及可行性。

方法

回顾性分析2020年2月四川大学华西第二医院妇科1例意外子宫内膜间质肉瘤患者的临床资料。

结果

患者2次TU-LESS均顺利完成，未发现腹腔内肿瘤播散。术后病理结果提示低级别子宫内膜间质肉瘤(low-grade endometrial stromal sarcoma, LGESS )。患者恢复良好，术后3个月复查阴道超声、阴道断端细胞学、肿瘤标志物及激素全套未见异常，目前继续严密随访中。

结论

LGESS术前极易误诊为子宫肌瘤，为改善预后，除了尽早明确诊断外，术中需严格无瘤操作，而TU-LESS可避免使用旋切器，对于子宫肌瘤的微创治疗是安全的、可行的，同时具有创伤小、疼痛轻、恢复快、切口美观等优点，值得临床推广。

关键词: 经脐单孔腹腔镜, 低级别子宫内膜间质肉瘤

Objective

To summarize the experience of transumbilical laparoendoscopic single-site surgery (TU-LESS) for an accidental endometrial stromal sarcoma, and investigate the safety and feasibility of the therapy for this disease.

Methods

The clinical datas of a case of accidental endometrial stromal sarcoma undergoing TU-LESS in the Department of Obstetrics and Gynecology, West China Second Hospital in Feb. 2020 were analyzed retrospectively.

Results

The operations were performed successfully and no intraperitoneal cancer spread were found. Postoperative pathological report suggests low-grade endometrial stromal sarcoma. The patient recovers well and continues to follow up closely. Three months after operation, the patient′s ultrasound, vaginal cuff cytology, tumor markers and hormone examination were normal.

Conclusions

Low-grade endometrial stromal sarcoma is easily misdiagnosed as uterine leiomyoma before operation. In order to improve the prognosis, in addition to early diagnosis, the principle of tumor-free should be strictly observed during operation. TU-LESS, avoiding the use of electric or power morcellators, is safe and feasible for the treatment of minimally invasive treatment of uterine leiomyoma, with the advantages of least invasion, lesser postoperative pain, faster recovery, and better cosmetic result. Therefore, TU-LESS is worth popularizing.

Key words: Transumbilical laparoendoscopic single site surgery, Low-grade endometrial stromal sarcoma

图1 术前盆腔超声检查

图2 术中在瘤体周围垫标本袋继续剥除

图3 术中将瘤体放入标本袋中并经脐部切口以"削苹果法"冷刀旋切取出

图4 第1次手术后病理检查

图5 第2次手术前盆腔MRI检查

图6 第2次手术后病理检查

图7 第2次手术后病理检查

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