Nakayama Kentaro, Tsukao Mayu, Ishikawa Masako, Ishibashi Tomoka, Nakamura Kohei, Sanuki Kaori, Yamashita Hitomi, Ono Ruriko, Minamoto Toshiko, Kyo Satoru
Department of Obstetrics and Gynecology, Shimane University School of Medicine, Izumo, Shimane 6938501, Japan.
Mol Clin Oncol. 2017 May;6(5):655-660. doi: 10.3892/mco.2017.1217. Epub 2017 Apr 10.
Ureterolysis is a surgical method with a high level of difficulty, which may be necessary when performing total laparoscopic hysterectomy (TLH) for large cervical myoma, despite the benign nature of this tumor. The aim of the present study was to introduce techniques that are commonly applied in malignant tumor surgery in order to safely perform TLH for large cervical myoma. Between 2014 and 2016, TLH was performed at the Shimane University Hospital (Izumo, Japan) in 153 patients with benign tumors, including 25 cases with a large uterus (uterine weight ≥500 g). The surgical methods applied in 3 of these large uterine cervical myoma cases were investigated in detail, including techniques devised by our department. TLH was performed without enucleating myomectomy in all 3 cases; however, all 3 cases required ureterolysis, transection of the anterior layer of the vesicouterine ligament and isolation of the ureter. In conclusion, although radical laparoscopic hysterectomy is commonly performed for cervical cancer at our department, techniques used for malignant tumor surgery may prove useful for benign cases with a high level of difficulty.
输尿管松解术是一种难度较高的手术方法，对于巨大宫颈肌瘤患者行全腹腔镜子宫切除术（TLH）时可能是必要的，尽管该肿瘤为良性。本研究的目的是介绍常用于恶性肿瘤手术的技术，以便安全地为巨大宫颈肌瘤患者实施TLH。2014年至2016年期间，岛根大学医院（日本出云）对153例良性肿瘤患者实施了TLH，其中包括25例子宫较大（子宫重量≥500 g）的患者。对其中3例巨大子宫宫颈肌瘤病例所应用的手术方法进行了详细研究，包括本部门设计的技术。所有3例均未行肌瘤剜除术而实施了TLH；然而，所有3例均需要进行输尿管松解术、膀胱子宫韧带前层横断术及输尿管游离术。总之，尽管本部门通常对宫颈癌实施根治性腹腔镜子宫切除术，但用于恶性肿瘤手术的技术可能对高难度良性病例有用。
