Shinohara Satoshi, Sakamoto Ikuko, Numata Masahiro, Ikegami Atsushi, Teramoto Katsuhiro
Department of Obstetrics and Gynecology, Yamanashi Prefectural Central Hospital, Kofu, Yamanashi, 1-1-1 Fujimi, Kofu, Yamanashi 400-8506, Japan.
Gynecol Minim Invasive Ther. 2017 Jul-Sep;6(3):113-115. doi: 10.1016/j.gmit.2016.10.002. Epub 2016 Dec 31.
To evaluate the risk of spilling cancer cells during total laparoscopic hysterectomy (TLH) using a uterine manipulator in early-stage endometrial cancer patients.
We conducted a prospective study among women undergoing TLH for Clinical Stage IA endometrial cancer between March 2015 and November 2015. Peritoneal washings before the insertion of the uterine manipulator and after TLH were obtained. The two sets of washings were reviewed by a cytopathologist to determine the presence or absence of malignant cells in a blinded manner.
Thirteen endometrial cancer patients (age 39-79 years, median: 62.2 years) were enrolled. The postoperative tumor grades were: G1: 11 (84.6%) and G2: 2 (15.4%). All patients underwent TLH and bilateral salpingo-oophorectomy. Pelvic/para-aortic lymph node dissection was not performed in all cases. Only one patient showed positive peritoneal cytology in the pre-TLH sample. There was high agreement (92.3%) between the two sets of washings in all patients. No patients received postoperative treatment.
We conclude that fallopian tubal cauterization is sufficient to provide protection from the dissemination of cancer cells into the peritoneal cavity at the time of TLH for endometrial cancers in early stages.
评估在早期子宫内膜癌患者中使用子宫操纵器进行全腹腔镜子宫切除术（TLH）时癌细胞播散的风险。
我们对2015年3月至2015年11月期间因临床分期IA期子宫内膜癌接受TLH的女性进行了一项前瞻性研究。在插入子宫操纵器之前和TLH之后获取腹腔冲洗液。两组冲洗液由细胞病理学家进行盲法检查以确定是否存在恶性细胞。
纳入了13例子宫内膜癌患者（年龄39 - 79岁，中位数：62.2岁）。术后肿瘤分级为：G1：11例（84.6%），G2：2例（15.4%）。所有患者均接受了TLH和双侧输卵管卵巢切除术。并非所有病例都进行了盆腔/腹主动脉旁淋巴结清扫。仅1例患者在TLH前样本中显示腹腔细胞学阳性。所有患者两组冲洗液之间的一致性较高（92.3%）。没有患者接受术后治疗。
我们得出结论，对于早期子宫内膜癌患者，在TLH时输卵管烧灼足以防止癌细胞播散至腹腔。
