切换至 "中华医学电子期刊资源库"

中华腔镜外科杂志(电子版) ›› 2021, Vol. 14 ›› Issue (01) : 53 -57. doi: 10.3877/cma.j.issn.1674-6899.2021.01.012

所属专题: 经典病例

病例报告

腹腔镜手术治疗宫颈癌复发一例
潘玉英1, 孙力2,(), 王桂香1, 李华1, 杨萌1   
  1. 1. 518172 深圳,国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院深圳医院妇科
    2. 100021 北京,国家癌症中心/国家肿瘤临床研究中心/中国医学科学院北京协和医学院肿瘤医院
  • 收稿日期:2020-12-05 出版日期:2021-02-28
  • 通信作者: 孙力
  • 基金资助:
    深圳市医疗卫生三名工程项目(SZSm201812075)

A case of recurrent cervical cancer treated by laparoscopic operation

Yuying Pan1, Li Sun2,(), Guixiang Wang1, Hua Li1, Meng Yang1   

  1. 1. Cancer Hospital Chinese Academy of Medical Sciences, Shenzhen Center, Gynecology, Shenzhen 518172, China
    2. Cancer Hospital Chinese Academy of Medical Sciences, Beijing 100021, China
  • Received:2020-12-05 Published:2021-02-28
  • Corresponding author: Li Sun
引用本文:

潘玉英, 孙力, 王桂香, 李华, 杨萌. 腹腔镜手术治疗宫颈癌复发一例[J/OL]. 中华腔镜外科杂志(电子版), 2021, 14(01): 53-57.

Yuying Pan, Li Sun, Guixiang Wang, Hua Li, Meng Yang. A case of recurrent cervical cancer treated by laparoscopic operation[J/OL]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2021, 14(01): 53-57.

目的

通过1例宫颈癌术后并放化疗后阴道复发患者的个体化治疗,探讨此类患者的手术方案及手术难点。

方法

选取中国医学科学院肿瘤医院深圳医院1例宫颈癌手术并放化疗后阴道复发病例,复习文献并通过多学科诊疗制定个体化治疗方案,探讨该手术难点及处理对策。

结果

手术顺利完成,术中出血少,术后恢复顺利,无并发症。术后随访7个月,患者恢复良好,生活质量高。

结论

对于宫颈癌手术并放化疗后阴道复发患者,通过仔细甄选合适患者,选择全阴道切除术是可行的,其可以有效切除病灶,延长患者生存期,改善生活质量,使患者最大限度地获益。但此类患者的手术治疗需要手术医师具备更高的手术技术及心理素质,同时需远期随访及进一步研究来评估其手术治疗的安全性及有效性。

Objective

Cervical cancer is one of the common malignant tumors in gynecology, and the treatment of patients with vaginal recurrence after surgery and radiotherapy for cervical cancer is the most challenging problem. The purpose of this paper is to discuss the surgical plan and surgical difficulties of such patients through individualized treatment and literature review of vaginal recurrence after surgery and radiotherapy for cervical cancer.

Methods

A case of vaginal recurrence after surgery and radiotherapy for cervical cancer was selected from Cancer Hospital Chinese Academy of Medical Sciences, Shenzhen Center. The case was reviewed in the literature and individualized treatment plan was formulated through Multi-disciplinary Treatment (MDT), and the surgical difficulties and management measures were discussed.

Results

The surgery was completed successfully with minimal intraoperative bleeding and smooth postoperative recovery with no complications. At the postoperative follow-up of 7 months, the patients recovered well and had a high quality of life.

Conclusions

For patients with vaginal recurrence after surgery and radiotherapy for cervical cancer, it is feasible to choose total vaginal resection through careful selection of suitable patients, which can effectively remove the lesion, prolong the patient′s survival, improve the quality of life, and benefit the patient to the maximum. However, surgical treatment of these patients requires a higher level of surgical skill and psychological competence on the part of the surgeon, as well as long-term follow-up and further studies to assess the safety and efficacy of the surgical treatment.

图1 阴道镜检查
图2 盆腔MRI
图3 术中所见
图4 打开阴道残端表面腹膜
图5 打开直肠右旁间隙
图6 下推直肠
图7 下推膀胱
图8 切开阴道左旁间隙
图9 全阴道
1
郑荣寿,孙可欣,张思维,等.2015年中国恶性肿瘤流行情况分析[J].中华肿瘤杂志,2019,41(1):19-28.
2
Monk BJ, Tewari KS. Evidence-based therapy for recurrent cervical cancer[J]. Journal of Clinical Oncology Official Journal of the American Society of Clinical Oncology, 2014, 32(25): 2687-2690.
3
江萍,张福泉,程光惠,等.复发宫颈癌近距离治疗专家共识[J].中华放射肿瘤学杂志,2020,29(9):721-729.
4
彭莛婷.复发性宫颈癌治疗策略研究进展[J].现代医药卫生,2020,36(21):3446-3450.
5
Abu-Rustum NR, Yashar CM, Bean S, et al. NCCN guidelines insights: cervical cancer, version 1.2020[J]. J Natl Compr Canc Netw, 2020, 18(6): 660-666.
6
Nakayama K, Teshima H, Hirai Y, et al. Stump recurrence after radical hysterectomy for patients with uterine cervical cancer (in Japanese) [J]. Nihon Sanka Fujinka Gakkai Zasshi, 1990, 42(3): 241-245.
7
Kozai Y, Itoh Y, Kawamura M, et al. High-dose-rate intracavitary brachytherapy for recurrent cervical cancer in the vaginal stump after hysterectomy[J]. Nagoya J Med Sci, 2019, 81(3): 351-358.
8
Mabuchi S, Takahashi R, Isohashi F, et al. Reirradiation using high-dose-rate interstitial brachytherapy for locally recurrent cervical cancer: a single institutional experience [J] . Int J Gynecol Cancer, 2014, 24(1): 141-148.
9
Panici PB, Manci N, Bellati F, et al. Vaginectomy: a minimally invasive treatment for cervical cancer vaginal recurrence[J]. Int J Gynecol Cancer, 2009, 19(9): 1625-1631.
10
Brader KR, Morris M, Levenback C, et al. Chemotherapy for cervical carcinoma: factors determining response and implications for clinical trial design[J]. J Clin Oncol, 1998, 16(5): 1879-1884.
11
Tewari KS, Sill MW, Long HJ, et al. Improved survival with bevacizumab in advanced cervical cancer[J]. N Engl J Med, 2014, 370(8): 734-743.
12
Berek JS, Howe C, Lagasse LD, et al. Pelvic exenteration for recurrent gynecologic malignancy: survival and morbidity analysis of the 45-year experience at UCLA[J]. Gynecol Oncol, 2005, 99(1): 153-159.
13
Abe A, Matoda M, Okamoto S, et al. Resection of the vaginal vault for vaginal recurrence of cervical cancer after hysterectomy and brachytherapy[J]. World J Surg Oncol, 2015. DOI: 10.1186/s12957-015-0495-8
14
颜士杰,陈炎.妇科内镜并发症的防治[J/CD].中华腔镜外科杂志(电子版),2016,9(2):77-79.
15
Liu J, Kohn J, Sun B, et al. Transvaginal Natural Orifice Transluminal Endoscopic Surgery Sacrocolpopexy: Tips and Tricks[J].J Minim Invasive Gynecol, 2019, 26(1): 38-39.
16
胡海,徐安安. "以史为鉴"——倡导当前胆囊结石个体化治疗策略[J/CD].中华腔镜外科杂志(电子版),2020,13(1):14-19.
[1] 王一然, 王平. 《巴西肿瘤外科协会盆腔廓清术治疗宫颈癌指南》解读[J/OL]. 中华妇幼临床医学杂志(电子版), 2021, 17(02): 142-151.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?