阴式广泛联合经阴道内镜腹膜外淋巴结切除术

Vaginal radical hysterectomy combined with transvaginal endoscopic extraperitoneal lymph node dissection

目的探索经阴道广泛子宫切除术(laparoscopically assisted radical vaginal hysterectomy,LARVH)联合经阴道内镜腹膜外淋巴结切除术治疗早期宫颈癌的可行性。方法回顾性分析2019年7月至2021年12月在佛山市妇幼保健院妇科完成治疗的3例完全经阴道途径手术的早期宫颈癌患者的临床资料及随访结果。结果2例采用LARVH联合经阴道内镜腹膜外盆腔淋巴结切除术、1例采用经阴道宫颈广泛切除术联合经阴道内镜腹膜外盆腔淋巴结切除术。平均手术时间246.66 min,其中盆腔淋巴结清扫部分的平均手术时间172.33 min;平均术中出血量123.33 ml,无术中并发症;3例盆腔淋巴结切除数目分别为26、21、14枚,均在术后2 d肛门恢复排气,术后2例出现盆腔淋巴囊肿。术后最长随访时间3年,无复发、死亡。结论LARVH联合经阴道内镜腹膜外淋巴结切除术治疗早期宫颈癌是可行、安全的。

Objective To explore the feasibility and safety of vaginal radical hysterectomy combined with transvaginal endoscopic extraperitoneal lymph node dissection(vNOTES Assisted VRH) for early-stage cervical cancer.Methods Retrospectively analyzed three cases with early-stage cervical cancer treated with vNOTES Assisted VRH in the Department of Gynecology, Foshan Women and Children Hospital.Results Vaginal radical hysterectomy combined with transvaginal endoscopic extraperitoneal lymph node dissection was performed in two patients early-stage cervical cancer, vaginal radical trachelectomy combined with transvaginal endoscopic extraperitoneal lymph node dissection was performanced in one case. The average operative time was 246.66 minutes, including an average of 172.33 minutes for the pelvic lymph node dissection, with an average operative blood loss of 123.33 ml. There were no intraoperative complications. Postoperative pathology confirmed that the number of resected pelvic lymph nodes were 26, 21, and 14, respectively. All patients recovered anal exhaust on the second day after operation. 2 patients developed postoperative pelvic lymphatic cysts. No recurrence or death within 3 years of post-operative follow-up.Conclusions vNOTES Assisted VRH is feasible and safe for the treatment of early-stage cervical cancer, but more studies are needed to prove it.