Fujiwara Hiroshi, Nakashima Masakazu, Banno Haruka, Hikami Kensuke, Yamada Yuya, Tamaki Masahiro, Ito Noriyuki
The Department of Urology, Japan Red Cross Wakayama Medical Center.
Hinyokika Kiyo. 2021 Jan;67(1):31-35. doi: 10.14989/ActaUrolJap_67_1_31.
A 66-year-old woman underwent concurrent chemoradiotherapy (CCRT) for stage IIA cervical cancer. However, two recurrent masses were detected at the vaginal stump 6 years after CCRT, and we performed laparoscopic total pelvic exenteration to obtain a complete cure. Because the terminal ileum appeared white secondary to the effects of radiotherapy, we constructed an ileal conduit using the ileum, approximately 40 cm toward the mouth from the ileocecum. We performed transperineal resection of the vagina and urethra and intersphincteric resection as anal-preservation surgery along with transverse colostomy. We used a right short gracilis myocutaneous flap to reconstruct the pelvic floor and perineum. The operation time was 816 min, and the estimated blood loss was 1,168 ml. On histopathological examination of the resected specimen, the parauterine tissue showed a positive surgical margin. Patients with recurrent cervical cancer after CCRT show poor prognosis. Complete resection with a negative margin is associated with more favorable prognosis in patients with recurrent pelvic masses. Compared with an open procedure, laparoscopic pelvic exenteration is safe and feasible in these patients. Selection of an optimal surgical approach, urinary diversion, and pelvic floor reconstruction is important for complete resection and prevention of perioperative complications.
一名66岁女性因IIA期宫颈癌接受同步放化疗（CCRT）。然而，CCRT 6年后在阴道残端发现两个复发肿块，我们进行了腹腔镜全盆腔脏器切除术以实现完全治愈。由于放疗影响，末端回肠呈白色，我们从回盲部向口侧约40 cm处取用回肠构建回肠导管。我们进行了经会阴阴道和尿道切除术以及作为保肛手术的括约肌间切除术并进行了横结肠造口术。我们使用右侧短股薄肌肌皮瓣重建盆底和会阴。手术时间为816分钟，估计失血量为1168毫升。在对切除标本进行组织病理学检查时，子宫旁组织显示手术切缘阳性。CCRT后复发宫颈癌的患者预后较差。切缘阴性的完全切除与盆腔肿块复发患者更有利的预后相关。与开放手术相比，腹腔镜盆腔脏器切除术在这些患者中是安全可行的。选择最佳手术方式、尿流改道和盆底重建对于完全切除和预防围手术期并发症很重要。
