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腹腔镜次全子宫切除并粉碎术治疗高危子宫内膜癌中的前哨淋巴结定位

Sentinel node mapping in high risk endometrial cancer after laparoscopic supracervical hysterectomy with morcellation.

作者信息

Buda Alessandro, Marco Cuzzocrea, Dolci Carlotta, Elisei Federica, Baldo Romina, Locatelli Luca, Milani Rodolfo, Messa Cristina

机构信息

Gynecology & Obstetrics Department, University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy.

出版信息

Int J Surg Case Rep. 2013;4(10):809-12. doi: 10.1016/j.ijscr.2013.06.010. Epub 2013 Jul 16.

Abstract

INTRODUCTION

Occult endometrial cancer after supracervical hysterectomy is very uncommon. Even if optimal management of those rare cases is still unproven, to guide the need for further therapies, restaging should be recommended in this situation.

PRESENTATION OF CASE

We report of a 60-year old woman with occult high risk endometrial cancer after supracervical hysterectomy with morcellation. We describe the feasibility of laparoscopic intraoperative sentinel node identification with cervical stump removing to restage the suspicious early stage high risk endometrial cancer.

DISCUSSION

In high risk endometrial cancer surgical restaging is important, considering that 10-35% of cases can present pelvic nodal metastasis. To reduce the treatment related morbidity maintaining the benefit of surgical staging, with a negative preoperative PET/CT, we performed a laparoscopic SN mapping with cervical stump removing.

CONCLUSION

This report highlight the fact that SN mapping with cervical injection is a feasible and safe technique also without the uterine corpus after supracervical hysterectomy with morcellation.

摘要

引言

次全子宫切除术后隐匿性子宫内膜癌非常罕见。即使这些罕见病例的最佳治疗方法仍未得到证实,但为了指导进一步治疗的必要性,在这种情况下应建议进行再分期。

病例介绍

我们报告了一名60岁女性,在次全子宫切除加粉碎术术后患有隐匿性高危子宫内膜癌。我们描述了在切除宫颈残端的情况下,腹腔镜术中识别前哨淋巴结以对可疑的早期高危子宫内膜癌进行再分期的可行性。

讨论

在高危子宫内膜癌中,手术再分期很重要,因为10%至35%的病例可能出现盆腔淋巴结转移。为了在保持手术分期益处的同时降低治疗相关的发病率,在术前PET/CT检查为阴性的情况下,我们进行了切除宫颈残端的腹腔镜前哨淋巴结定位。

结论

本报告强调了这样一个事实,即对于次全子宫切除加粉碎术术后的患者,即使没有子宫体,经宫颈注射进行前哨淋巴结定位也是一种可行且安全的技术。

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