Murray Bria, Smith Caleigh E, Alsina Jorge, Howard Megan, Landen Charles, Gehrig Paola A
University of Virginia, Department of Obstetrics and Gynecology, United States.
University of Virginia, School of Medicine, United States.
Gynecol Oncol Rep. 2024 May 18;54:101416. doi: 10.1016/j.gore.2024.101416. eCollection 2024 Aug.
Vaginal cuff dehiscence (VCD) in the setting of acute infection is an uncommon but serious complication of total hysterectomy without clear guidelines for management. There is a need for further documentation of best practices around treatment, particularly when it comes to surgical drain utilization and placement.
We present a case of a 68-year-old with primary peritoneal carcinoma who underwent a robot-assisted total laparoscopic hysterectomy as part of an interval debulking surgery and had a VCD. The cuff was repaired vaginally in the operating room with placement of a Malecot catheter for pelvic abscess drainage.
The literature is sparse in regard to clear guidelines for management of VCD. Surgical and expectant management approaches are dependent on patient stability, surgical experience, local practice norms, and evidence of intra-abdominal injury. Interventional radiology has become a primary source of drain placement in management of VCD and vaginal cuff abscess. Malecot drains are a low cost, and effective intervention for such management and an important resource for the gynecologic surgeon.
急性感染情况下的阴道残端裂开（VCD）是全子宫切除术后一种罕见但严重的并发症，目前尚无明确的管理指南。需要进一步记录治疗的最佳实践，尤其是在手术引流管的使用和放置方面。
我们报告一例68岁原发性腹膜癌患者，其作为间隔减瘤手术的一部分接受了机器人辅助全腹腔镜子宫切除术，并发生了VCD。在手术室经阴道修复残端，并放置Malecot导管用于盆腔脓肿引流。
关于VCD管理的明确指南，文献资料较少。手术和保守管理方法取决于患者的稳定性、手术经验、当地的实践规范以及腹腔内损伤的证据。介入放射学已成为VCD和阴道残端脓肿管理中引流管放置的主要来源。Malecot引流管是这种管理的一种低成本且有效的干预措施，也是妇科外科医生的一项重要资源。
