Escobar Pamela A, Gressel Gregory M, Goldberg Gary L, Kuo Dennis Yi-Shin
Montefiore Medical Center and Albert Einstein College of Medicine, Department of Obstetrics & Gynecology and Women's Health, 1825 Eastchester Road, Room 722, Bronx, NY 10463, USA.
Case Rep Obstet Gynecol. 2016;2016:5296536. doi: 10.1155/2016/5296536. Epub 2016 Mar 27.
Background. Vaginal cuff dehiscence after hysterectomy has varying incidence according to surgical approach, with highest rates associated with laparoscopic surgery. Comparative data on timing of diagnosis describe a wide range of clinical presentation from weeks to years after hysterectomy. Limited reports have focused specifically on delayed presentation of vaginal cuff dehiscence. Cases. All cases of vaginal cuff dehiscence at our institution between 2005 and 2015 were collectively reviewed and three cases were identified of women who presented with cuff dehiscence greater than 180 days from index surgery. Diagnosis occurred at 342 to 461 days after operation. One patient presented with abdominal pain, a second case presented with vaginal discharge, and the third case lacked clinical symptoms altogether. Prior to diagnosis, one case received chemotherapy and external beam radiation for Stage IB1 cervical cancer and another case received external beam radiation alone for Stage II endometrioid adenocarcinoma. All cuffs were repaired vaginally with interrupted, early absorbable suture. Conclusion. Robotic total laparoscopic hysterectomy may be associated with increased risk of vaginal cuff dehiscence. Further studies are needed to determine risk factors and patient characteristics associated with delayed presentation of vaginal cuff dehiscence in robotic total hysterectomy as well as all surgical approaches.
背景。子宫切除术后阴道残端裂开的发生率因手术方式而异，腹腔镜手术的发生率最高。关于诊断时间的比较数据表明，子宫切除术后数周至数年的临床表现范围广泛。有限的报告专门关注阴道残端裂开的延迟表现。病例。对我院2005年至2015年间所有阴道残端裂开病例进行了综合回顾，确定了3例患者，其阴道残端裂开距离初次手术超过180天。诊断发生在术后342至461天。1例患者表现为腹痛，第2例表现为阴道分泌物，第3例完全没有临床症状。诊断前，1例因IB1期宫颈癌接受了化疗和外照射，另1例因II期子宫内膜样腺癌仅接受了外照射。所有残端均采用间断、早期可吸收缝线经阴道修复。结论。机器人全腹腔镜子宫切除术可能与阴道残端裂开风险增加有关。需要进一步研究以确定与机器人全腹腔镜子宫切除术以及所有手术方式中阴道残端裂开延迟表现相关的危险因素和患者特征。
