先封闭子宫颈癌瘤体法的无瘤化免举宫腹腔镜广泛性子宫切除改良手术20例分析

Clinical analysis of 20 cases of LRH for cervical cancer without tumor exposure by sealing the tumor.

目的探讨子宫颈癌腹腔镜广泛性子宫切除(laparoscopic radical hysterectomy,LRH)简单而安全的手术方法。方法选择2019年5月至2020年3月于中国医科大学附属盛京医院第二微创妇科就诊的无手术禁忌证的20例ⅠA2~ⅠB1期(2018年FIGO分期)需要LRH手术治疗的子宫颈癌患者(鳞癌18例,腺癌2例)为研究对象。术中先经阴道在拟切除阴道的下缘分离并缝合阴道前后壁断端以封闭子宫颈癌瘤体,并进一步分离膀胱阴道间隙及直肠阴道间隙直达前后反折腹膜,确保LRH手术在无肿瘤暴露及免举宫器的情况下完成。结果所有病例均顺利完成手术。封闭肿瘤后的阴道冲洗液及结束手术后的盆腔冲洗液的肿瘤细胞学检查均阴性,主韧带、宫骶韧带及阴道切除的长度均≥3 cm,标本切缘均阴性。结论此术式改良方法在满足子宫颈癌标准的LRH手术切除范围的同时,不但能确保手术过程中最大限度的遵循手术操作的无瘤原则,而且能使LRH手术变得相对的简单而安全。

Objective To explore a new surgical method which can ensure there is no tumor exposure during the whole process of laparoscopic radical hysterectomy(LRH)and can make the LRH simple and safe.Methods From May 2019 to March 2020,20 cervical cancer patients(18 cases of squamous cell carcinoma and 2 cases of adenocarcinoma)were treated in Shengjing Hospital of China Medical University,who needed LRH treatment,and they were enrolled in this study.The patient’s clinical stage wasⅠA2-ⅠB1(FIGO Stage 2018),and there were no operation contraindiacations in all patients.The first step of operation was to determine the lower margin of vagina wall to be removed,then the vaginal wall was dissected from bladder and rectum,and the cut end of the anterior and posterior wall of the vagina was sutured to seal the tumor of cervical cancer.After that,cystovaginal space and rectovaginal space were further separated to reach the anterior and posterior reflexional peritoneum,so as to ensure the completion of LRH surgery without tumor exposure,and the manipulator was not needed in the surgery.Results The operation was successfully performed in all patients.The cytological examination of the vaginal flushing saline after the sealing of the tumor and that of the pelvic flushing saline at the end of the operation was negative,the length of the cardinal ligament,the sacral ligament and the vaginal wall resected were all≥3 cm,and the incised margins of the specimen were all negative.Conclusion This modified operation method can not only ensure that the standard LRH is performed without tumor exposure but also make LRH become easier and safer.