腹腔镜下广泛性阴道旁组织切除术治疗全子宫切除术后阴道残端癌3例报告

Comprehensive Resection of the Paracolpium by Laparoscopy for Post-panhysterectomy Vaginal Stump Carcinoma:Report of 3 Cases

目的探讨腹腔镜广泛性阴道旁组织切除及盆腔、腹主动脉旁淋巴结切除术在全子宫切除术后阴道残端癌治疗中应用。方法 2008年4月～2011年6月,3例全子宫切除术后阴道残端癌,行腹腔镜阴道残端肿物切除、广泛阴道旁组织切除、盆腔淋巴结清扫术,其中1例行腹主动脉旁淋巴结切除术。结果 3例手术均顺利,手术时间分别为330、487、327min,出血量200、150、100 ml,切除盆腔淋巴结26、20、30枚,例3切除腹主动脉旁淋巴结12枚,其中例1术后病理证实有盆腔淋巴结转移。术中无并发症发生。3例术后第2天均肠道功能恢复,术后14天拔除尿管,尿潴留2例,予重置尿管。3例术后随访48、14和10个月,未发现局部复发和全身转移。结论对全子宫切除术后阴道残端癌,行腹腔镜下阴道残端肿物切除、广泛性阴道旁组织切除术和盆腔淋巴结清扫术安全、有效,且疗效满意。

Objective To study the feasibility and efficacy of comprehensive resection of the paracolpium by laparoscopy for patients with vaginal stump carcinoma after radical hysterectomy. Methods From April 2008 to June 2011, 3 patients with post- panhysterectomy vaginal stump carcinoma received laparoscopic radical resection of the paracolpium, vaginal stump lesion, and pelvic lymph nodes （one of the patients received paraaortic lymphadenectomy）. Results The procedure was completed in all the three patients within 330,487, or 327 minutes, with an intraoperative blood loss of 200, 150, and 100 ml. In the patients, 26, 20, and 30 lymph nodes were resected respectively, and in the patients who received paraaortic lymphadenectomy, 12 paraaortic lymph nodes were removed. Pelvic lymphatic metastasis was detected in one of the cases postoperation. No intraoperative complications occurred. The gastrointestinal function was recovered in day 2 after the surgery in all the cases, and the urinary catheter was removed on day 14; two of the patients underwent re-catheterization after that because of urinary retention. The patients were followed up for 48, 14, and 10 months respectively, during which no local recurrence or systemic metastasis occurred. Conclusion For patients with post- panhysterectomy vaginal stump carcinoma, laparoscopic radical resection of the paracolpium, vaginal stump lesion, and pelvic lymph nodes is feasible, safe, and effective.