腹腔镜宫颈广泛切除术治疗特殊类型宫颈黏液性癌

doi:10.3877/cma.j.issn.1674-6899.2022.06.011

中华腔镜外科杂志(电子版) ›› 2022, Vol. 15 ›› Issue (06) : 372 -375. doi: 10.3877/cma.j.issn.1674-6899.2022.06.011

临床技术

腹腔镜宫颈广泛切除术治疗特殊类型宫颈黏液性癌

王莹莹¹, 王卡娜¹, 陈思敬¹, 王娜¹, 郑莹¹^,^†(

)

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

收稿日期:2022-06-17 出版日期:2022-12-30
通信作者: 郑莹
基金资助:
四川省科技厅重点研发项目(2020YFS0049); 成都市科技局技术创新研发项目(2019-YF05-00473-SN)

Laparoscopic radical trachelectomy for early cervical cancer

Yingying Wang¹, Kana Wang¹, Sijing Chen¹, Na Wang¹, Ying Zheng¹^,^†()

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

Received:2022-06-17 Published:2022-12-30
Corresponding author: Ying Zheng

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目的

探讨欲保留生育功能的特殊类型宫颈癌患者行腹腔镜宫颈广泛切除术(radical trachelectomy, RT)的安全性及可行性。

方法

回顾性分析2020年12月四川大学华西第二医院妇科一例ⅠB1期宫颈黏液性癌患者的临床资料，展现手术视频，总结术中技术要点。

结果

患者手术顺利，术后病理：子宫颈浸润性复层产黏液性癌。术后患者口服米非司酮2.5个月，紫杉醇+顺铂化疗4次，恢复良好，定期复查未见异常，月经规律，无经血不畅，卵巢功能正常，目前积极备孕中。

结论

对于特殊类型的宫颈癌，腹腔镜RT，切除足够范围的宫旁组织、保证切缘阴性是保留生育功能手术的关键；识别宫旁间隙、减少出血和避免输尿管损伤是术中的重点、难点；前哨淋巴结切除的应用而非系统淋巴结清扫，以及子宫动脉上行支的保留，对减少盆腔粘连、最大程度保留患者子宫血供有意义。

关键词: 宫颈癌, 浸润性复层产黏液性癌, 宫颈广泛切除术, 腹腔镜, 前哨淋巴结清除术

Objective

To explore the safety and feasibility of laparoscopic radical trachelectomy in patients with uncommon subtype of cervical cancer who want to preserve reproductive function.

Methods

Retrospectively analyze the clinical datas of a case of invasive stratified mucin-producing carcinoma in the Department of Obstetrics and Gynecology, West China Second Hospital of Sichuan University in Dec. 2020. To show the steps of the surgery, and to summarize the technical points.

Results

The surgery was successfully operated and the postoperative pathology showed invasive stratified mucin-producing carcinoma. After the surgery, the patient took mifepristone orally for 2.5 months and paclitaxel + cisplatin for chemotherapy 4 times. She recovered well. Regular review showed no abnormality, no menstrual irregularity, no menstrual blood obstruction, and normal ovarian function. The patient is currently preparing to conceive.

Conclusions

Laparoscopic radical trachelectomy for uncommon subtype of cervical cancer is safe and effective. It′s essential to remove sufficient range of paracervical tissue and ensure the incisal margin to be negative. The points and difficulties are that identifying the paracervial spaces, reducing bleeding and avoiding ureteral injury during the operation. The use of sentinel lymph node dissection and the preservation of the upper branch of uterine artery may make sense for reducing pelvic adhesion and preserving ovarian blood supply to the maximum extent.

Key words: Cervical cancer, Invasive stratified mucin-producing carcinoma, Radical trachelectomy, Laparoscopy, Pelvic lymph node dissection

图1 盆腔MRI注：宫颈肥大，前唇外口(约12点方向)可见肿块影，大小约1.0 cm×0.9 cm×0.9 cm，累及宫颈浅层基质环

图2 腹腔镜腹部穿刺切口

图3 切取的宫颈断端组织注：A.宫颈断端组织；B.癌距离宫颈管内口切缘最近处约7 mm

图4 术后病理复层宫颈产黏液性癌注：A.HE×40；B. HE×100

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