Onigahara Mikihisa, Yanazume Shintaro, Ushiwaka Takashi, Togami Shinichi, Kamio Masaki, Kobayashi Hiroaki
Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima, Japan.
Gynecol Minim Invasive Ther. 2021 Apr 30;10(2):127-131. doi: 10.4103/GMIT.GMIT_114_19. eCollection 2021 Apr-Jun.
Cervical elongation in patients with pelvic organ prolapse (POP), who previously underwent laparoscopic sacrocolpopexy (LSC), is not fully understood. We report a case of a second surgery for endometrial cancer complicated with POP recurrence, which seemed to be related to cervical elongation following LSC. A 65-year-old woman was referred for invasive treatment following LSC. Although preoperative endometrial cytology was negative, the resected uterine specimen revealed endometrioid carcinoma. The patient also had complications of cervical prolapse with cystocele Stage III. Repeat surgery was performed with a trachelectomy, anterior-posterior colporrhaphy, and vaginal apex suspension. Mesh had been adequately sutured to the upper cervix in the previous surgery, and the resected cervix was elongated up to 9 cm. Cervical elongation may be correlated with the inaccurate preoperative endometrial examination, and it may also promote POP recurrence leading to a poorly supported pelvic floor. We suggest that cervical elongation should be identified before POP surgery.
盆腔器官脱垂（POP）患者在先前接受腹腔镜骶骨阴道固定术（LSC）后出现宫颈延长的情况尚未完全明确。我们报告了一例因子宫内膜癌并发POP复发而进行二次手术的病例，这似乎与LSC术后的宫颈延长有关。一名65岁女性在LSC术后被转诊接受侵入性治疗。尽管术前子宫内膜细胞学检查为阴性，但切除的子宫标本显示为子宫内膜样癌。该患者还伴有宫颈脱垂合并III度膀胱膨出的并发症。再次手术进行了宫颈切除术、前后阴道壁修补术和阴道顶端悬吊术。在先前的手术中，网片已充分缝合至宫颈上部，切除的宫颈延长至9厘米。宫颈延长可能与术前子宫内膜检查不准确有关，也可能促进POP复发，导致盆底支撑不良。我们建议在POP手术前应识别出宫颈延长。
