Department of Obstetrics and Gynecology, Kansai Medical University, Osaka, Japan.
Asian J Endosc Surg. 2023 Jan;16(1):82-85. doi: 10.1111/ases.13100. Epub 2022 Jul 11.
Vaginal stump recurrence post-hysterectomy for gynecologic malignancies occurs in 2%-3% of cases. Local excision has been recognized as the primary treatment of localized recurrence, in which precise surgical margin is critical. However, R0 resection is not always easy, given the deep and narrow operation field, as well as severe postoperative fibrosis or adhesion of the vaginal stump at times. Here, we report four cases of vaginal stump recurrence of gynecologic malignancies resected by bi-directional (laparoscopic and pneumovaginoscopic) endoscopy to overcome these difficulties. The primary tumors were uterine cancer in two cases and uterine cervical and ovarian cancer in one case each. The mean operating time was 199 (162-235) minutes, blood loss was minimal, and no perioperative complications were observed. Postoperative follow-up (7.0-19.4 months) revealed no recurrence. This combined procedure could be a therapeutic option for localized vaginal stump recurrence.
妇科恶性肿瘤子宫切除术后阴道残端复发的发生率为 2%-3%。局部切除术已被公认为局部复发的主要治疗方法，其中精确的手术切缘至关重要。然而，由于手术部位深而狭窄，以及阴道残端有时严重的术后纤维化或粘连，R0 切除并不总是容易的。在此，我们报告了 4 例妇科恶性肿瘤阴道残端复发的病例，这些病例通过双向（腹腔镜和经阴道气腹镜）内镜切除来克服这些困难。原发性肿瘤分别为子宫癌 2 例，子宫颈癌和卵巢癌各 1 例。平均手术时间为 199（162-235）分钟，出血量少，无围手术期并发症。术后随访（7.0-19.4 个月）未见复发。这种联合手术可能是治疗局限性阴道残端复发的一种选择。
