Rad Morva Tahmasbi, Wallwiener Markus, Schemmer Peter, Schott Sarah, Sohn Christof, Rom Joachim, Eichbaum Michael
Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany; Department of Obstetrics and Gynecology, University of Göttingen, Göttingen, Germany.
Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany.
J Obstet Gynaecol Can. 2012 Apr;34(4):363-366. doi: 10.1016/S1701-2163(16)35218-5.
Advances in surgical techniques and immunosuppressive therapy have improved graft survival in transplant recipients. However, intense long-term immunosuppression increases the incidence of cancer in these patients compared with the general population, not least because of viral infections. Cervical cancer is the third most common malignancy worldwide. In early invasive cervical cancer, surgery is the treatment of choice.
In 2010, we performed a laparoscopically assisted vaginal hysterectomy (LAVH) in a 42-year-old patient with micro-invasive cervical adenocarcinoma (FIGO stage IA1) who had undergone two liver transplantations in 2006 and 2008. The patient was followed up for 18 months after surgery. Despite upper abdominal adhesions and minor difficulties in inserting the Veress needle, the pneumoperitoneum was created safely. The procedure was completed within 157 minutes without any intraoperative complications. Blood loss was less than 100 mL. Postoperative course was uncomplicated with minimal fluctuations in liver function markers. Immunosuppressive therapy was continued without modification. The patient was discharged on postoperative day 9. No complications or recurrence were reported during the 18-month follow-up.
The laparoscopic approach is a justifiable form of surgical management in the treatment of a liver transplant recipient with early-stage cervical cancer.
手术技术和免疫抑制疗法的进步提高了移植受者的移植物存活率。然而，与普通人群相比，长期强化免疫抑制增加了这些患者患癌症的发生率，这尤其是因为病毒感染。宫颈癌是全球第三大常见恶性肿瘤。在早期浸润性宫颈癌中，手术是首选治疗方法。
2010年，我们为一名42岁的微浸润性宫颈腺癌（国际妇产科联盟（FIGO）IA1期）患者实施了腹腔镜辅助阴式子宫切除术（LAVH），该患者曾在2006年和2008年接受过两次肝移植。术后对患者进行了18个月的随访。尽管存在上腹部粘连且插入Veress针时遇到一些小困难，但仍安全地建立了气腹。手术在157分钟内完成，无任何术中并发症。失血少于100毫升。术后过程顺利，肝功能指标波动极小。免疫抑制治疗持续进行，未作调整。患者于术后第9天出院。在18个月的随访期间未报告任何并发症或复发情况。
腹腔镜手术方法是治疗早期宫颈癌肝移植受者的一种合理手术管理方式。
