Hu Kunpeng, Ke Yifan, Chen Qin, Wu Jiezhong, Ke Yingping, Xie Qiuxian, Liu Bo, Chen Jiajia
Department of General Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
Department of General Surgery, Chaozhou Central Hospital, Chaozhou, China.
Front Oncol. 2022 Jul 29;12:916104. doi: 10.3389/fonc.2022.916104. eCollection 2022.
With microtrauma becoming a consensus, in order to improve surgical treatment capability, the clinical application of laparoscopic multiorgan resection is becoming more and more complicated and diversified. Recently, we successfully presented a case of transvaginal specimen extraction surgery that included laparoscopic anatomical left hemihepatectomy combined with laparoscopic total hysterectomy and bilateral adnexectomy and the pelvic and para-aortic lymphadenectomy. The patient, a 75-year-old woman, was hospitalized with abnormal vaginal discharge and bleeding. The pathologic diagnosis of uterine curettage was endometrioid adenocarcinoma. After completing examinations such as color Doppler ultrasound, CEUS, MRCP and thoracoabdominal enhanced spiral CT, preoperative diagnosis was considered as endometrial cancer and a space-occupying lesion in the liver (primary or secondary site)?. No lymphatic or distant metastasis had been found. We also excluded Lynch syndrome by digestive endoscopy and gene sequencing. After a multidisciplinary consultation, the patient underwent surgery under general anesthesia on 24 September 2021. The operation was completed uneventfully in 6 hours, then the patient was transferred to the ICU for follow-up monitoring. The patient began to eat and was able to leave bed on the 4 postoperative day. According to immunohistochemistry, the patient's postoperative diagnosis was intrahepatic cholangiocarcinoma (ICC) and endometrial cancer. Compared with open surgery, laparoscopic multiorgan resection with natural orifice specimen extraction surgery (NOSES) has many advantages such as fewer traumas, shorter recovery time, and better postoperative quality of life. However, combined large-scale laparoscopic surgeries of different organs can be challenging for surgeons and anesthesiologists. No similar cases have been searched.
随着微创伤成为共识，为提高手术治疗能力，腹腔镜多器官切除术的临床应用正变得越来越复杂和多样化。最近，我们成功完成了一例经阴道标本取出手术，该手术包括腹腔镜解剖性左半肝切除术、腹腔镜全子宫切除术及双侧附件切除术以及盆腔和腹主动脉旁淋巴结清扫术。患者为一名75岁女性，因阴道分泌物异常和出血入院。刮宫病理诊断为子宫内膜样腺癌。在完成彩色多普勒超声、CEUS、MRCP和胸腹增强螺旋CT等检查后，术前诊断考虑为子宫内膜癌和肝脏占位性病变（原发或继发部位）？未发现淋巴或远处转移。我们还通过消化内镜检查和基因测序排除了林奇综合征。经过多学科会诊，患者于2021年9月24日在全身麻醉下接受手术。手术在6小时内顺利完成，随后患者被转入重症监护病房进行后续监测。患者术后第4天开始进食并能够下床活动。根据免疫组化结果，患者术后诊断为肝内胆管癌（ICC）和子宫内膜癌。与开放手术相比，采用经自然腔道标本取出手术（NOSES）的腹腔镜多器官切除术具有创伤小、恢复时间短和术后生活质量更好等诸多优点。然而，不同器官的联合大型腹腔镜手术对外科医生和麻醉医生来说可能具有挑战性。未检索到类似病例。
