经脐单孔腹腔镜手术治疗意外发现的低级别子宫内膜间质肉瘤一例体会

doi:10.12280/gjfckx.20220723

国际妇产科学杂志 ›› 2023, Vol. 50 ›› Issue (1): 50-53.doi: 10.12280/gjfckx.20220723

• 妇科肿瘤研究:病例报告 • 上一篇下一篇

经脐单孔腹腔镜手术治疗意外发现的低级别子宫内膜间质肉瘤一例体会

杨旭, 郑莹(), 陈思敬

610041 成都，四川大学华西第二医院妇科（杨旭，陈思敬），出生缺陷与相关妇儿疾病教育部重点实验室（郑莹）

收稿日期:2022-09-08 出版日期:2023-02-15 发布日期:2023-03-02
通讯作者: 郑莹 E-mail:zhy_chd@126.com
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)

The Experience of Transumbilical Laparoendoscople Single-Site Surgical Treatment by A Case of Accidental Detection of Low-Grade Endometrial Stromal Sarcoma

YANG Xu, ZHENG Ying(), CHEN Si-jing

Department of Gynecology (YANG Xu, CHEN Si-jing), Key Laboratory of Birth Defects and Related Maternal and Child Diseases of Ministry of Education (ZHENG Ying), West China Second Hospital, Sichuan University, Chengdu 610041, China

Received:2022-09-08 Published:2023-02-15 Online:2023-03-02
Contact: ZHENG Ying E-mail:zhy_chd@126.com

摘要/Abstract

摘要：

回顾总结1例经2次经脐单孔腹腔镜手术（transumbilical laparoendoscople single-site surgery，TU-LESS）治疗意外发现低级别子宫内膜间质肉瘤（low-grade endometrial stromal sarcoma，LG-ESS）的病例资料。患者初次手术术前诊断子宫肌瘤，通过行TU-LESS将子宫肌瘤剥除装袋冷刀旋切取出，术后病理确诊为LG-ESS，30 d后再次行TU-LESS全面分期手术见腹膜少许种植，术后给予孕激素治疗，随访20个月查肿瘤标志物正常，脐部切口及阴道断端愈合好。TU-LESS具有疼痛轻、伤口美观、术后恢复快等特点，最重要的是可安全有效取出肌瘤标本，避免了使用电动旋切器造成的肉瘤全腹广泛播散。但术中仍需警惕肌瘤剥除过程中肿瘤组织飞溅发生的腹膜种植，各操作环节均应注意严格遵循无瘤原则。

关键词: 子宫肿瘤, 肌瘤, 低级别子宫内膜间质肉瘤, 经脐单孔腹腔镜手术, 腹腔镜检查

Abstract:

This article reports a case of low-grade endometrial stromal sarcoma (LG-ESS), which was accidentally found after 2 times of transumbilical laparoendoscople single-site surgery (TU-LESS), retrospectively. The patient was diagnosed with uterine fibroid before the first operation. The uterine fibroid was removed by TU-LESS bag cold knife rotary cutting. The pathological diagnosis was LG-ESS after the operation. After 30 days, a small amount of peritoneal planting was seen in the TU-LESS comprehensive staging operation again. Progesterone treatment was given after the operation. The tumor markers were normal after 20 months of follow-up. The umbilical incision and vaginal stump healed well. TU-LESS has the characteristics of light pain, beautiful wound, and rapid postoperative recovery. The most important thing is that the myoma specimens can be safely and effectively removed to avoid the widespread of sarcoma in the whole abdomen caused by the use of electric rotary cutter. However, during the operation, it is still necessary to be vigilant for peritoneal implantation caused by tumor splash during myomectomy, and each operation should strictly follow the principle of tumor-free.

Key words: Uterine neoplasms, Myoma, Low-grade endometrial stromal sarcoma, Transumbilical laparoendoscople single-site surgery, Laparoscopy

杨旭, 郑莹, 陈思敬. 经脐单孔腹腔镜手术治疗意外发现的低级别子宫内膜间质肉瘤一例体会[J]. 国际妇产科学杂志, 2023, 50(1): 50-53.

YANG Xu, ZHENG Ying, CHEN Si-jing. The Experience of Transumbilical Laparoendoscople Single-Site Surgical Treatment by A Case of Accidental Detection of Low-Grade Endometrial Stromal Sarcoma[J]. Journal of International Obstetrics and Gynecology, 2023, 50(1): 50-53.

图/表 10

图1 初次手术前阴道彩色超声图

图2 初次手术标本

图3 初次手术术后病理图（HE染色×200）

图4 再次手术前CT

图5 左侧子宫骶韧带和直肠左侧壁结节（箭头所示）

图6 右侧卵巢漏斗韧带结节（箭头所示）

图7 再次手术术后子宫及双附件标本

图8 再次手术术后病理（HE染色×200）

图9 再次手术术后第2天脐部伤口

图10 再次手术术后20个月脐部伤口

参考文献 11

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经脐单孔腹腔镜手术治疗意外发现的低级别子宫内膜间质肉瘤一例体会

The Experience of Transumbilical Laparoendoscople Single-Site Surgical Treatment by A Case of Accidental Detection of Low-Grade Endometrial Stromal Sarcoma

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