Department of Obstetrics and Gynecology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China (mainland).
Am J Case Rep. 2022 Sep 8;23:e936694. doi: 10.12659/AJCR.936694.
BACKGROUND Conventional laparoscopic surgery and transvaginal natural orifice transluminal endoscopic surgery (vNOTES) both use CO2 pneumoperitoneum to expose the surgical space. However, CO₂ pneumoperitoneum is undoubtedly dangerous for patients with rheumatic heart disease (RHD) and can cause cardiopulmonary impairments. Therefore, we selected the sentinel lymph node (SLN) mapping strategy to guide the staging surgery via gasless vNOTES for an endometrial cancer (EC)-patient with comorbid RHD. Here, we discuss whether our selected surgical method was safe and feasible for this patient. CASE REPORT A 43-year-old woman with a history of RHD, severe mitral regurgitation, and pulmonary hypertension for more than 30 years received diagnostic curettage for irregular vaginal bleeding for more than 1 month. Pathological examinations revealed the occurrence of highly differentiated intrauterine endometrioid adenocarcinoma. She was admitted to the gynecological ward of our hospital for further surgery. We performed EC staging surgery with SLN mapping via gasless vNOTES and adopted a series of effective measures to solve the intraoperative complications of surgical space exposure. Surgery was successful. The patient recovered well and was discharged 5 days after surgery. She has been followed up in the gynecological clinic for nearly 1 year. At the time of this report, she had good recovery, no recurrence and metastasis, and normal tumor markers. CONCLUSIONS For EC patients with comorbid RHD pathology, application of staging surgery with SLN mapping via gasless vNOTES was shown to be safe and feasible. This approach is expected to be highly effective for patients with contraindications to CO2 pneumoperitoneum laparoscopy.
传统腹腔镜手术和经阴道自然腔道内镜手术（vNOTES）均使用 CO2 气腹来暴露手术空间。然而，CO₂气腹对风湿性心脏病（RHD）患者无疑是危险的，会引起心肺损伤。因此，我们选择了前哨淋巴结（SLN）的示踪策略，通过无气腹 vNOTES 为合并 RHD 的子宫内膜癌（EC）患者引导分期手术。在这里，我们讨论我们选择的手术方法对该患者是否安全可行。
一名 43 岁女性，患有 RHD 病史 30 余年，有严重二尖瓣反流和肺动脉高压。因不规则阴道出血 1 个月余行诊断性刮宫术。病理检查发现高度分化的宫腔内子宫内膜样腺癌。她因进一步手术被收入我院妇科病房。我们通过无气腹 vNOTES 进行了 EC 分期手术和 SLN 示踪，并采取了一系列有效的措施来解决手术空间暴露的术中并发症。手术成功。患者恢复良好，术后 5 天出院。她一直在妇科门诊进行近 1 年的随访。在本报告时，她恢复良好，无复发和转移，肿瘤标志物正常。
对于合并 RHD 病理的 EC 患者，应用无气腹 vNOTES 进行 SLN 示踪的分期手术是安全可行的。对于不能耐受 CO2 气腹腹腔镜的患者，这种方法有望非常有效。
