背景:细胞子宫平滑肌瘤(CL)是子宫平滑肌瘤的主要亚型。在这项研究中,我们报告一例单孔腹腔镜无气腹子宫肌瘤切除术2年后腹膜播散性子宫肌瘤复发。本文致力于研究上述外科手术的潜在局限性,并概述了原发性术后病理为CL的复发性病例的显着特征。此外,本研究旨在总结以往关于CL的回顾性研究,并提出可能作为细胞子宫肌瘤术后复发预测因子的免疫组织化学分子的存在.最终目标是提高临床医生对疾病的认识。
方法:两年前,患者接受了单孔无气腹腹腔镜子宫肌瘤切除术.3个月前做的妇科彩超显示子宫肌瘤复发,病人出现腹胀,轻度尿频,还有过去一个月的便秘.
方法:第二次手术后,对子宫肿块和转移性病变进行全面的病理检查和免疫组织化学分析显示,明确的诊断是CLs。
方法:患者行全子宫切除术,双侧输卵管切除术,盆腔粘连松解术,网膜肿块切除术,肠系膜肿块切除术,盆腔腹膜肿块切除术。所有标本均被送去进行快速冷冻检查,并显示为平滑肌瘤。
结果:患者于术后第10天出院。在文章撰写之日,患者1年5个月无复发.
结论:单端口无气体入路未能达到预期的减少肌瘤复发,正如外科医生所预期的那样。将肿瘤拉向腹部切口切除的动作,相反,可能是导致CL腹膜播散平滑肌瘤病术后复发的医源性因素。单端口无气体辅助袋可能是子宫肌瘤切除术的更合适的选择。应尽最大努力防止由医源性因素引起的肌瘤的潜在复发。
BACKGROUND: Cellular uterine leiomyomas (CL) represent the prevailing subtype among uterine leiomyomas. In this study, we report a
case of recurrent peritoneal disseminated uterine fibroids 2 years after single-port laparoscopic gasless myomectomy. This article endeavors to examine the potential limitations of the aforementioned surgical procedure and outline the distinguishing features of recurrent cases with primary postoperative pathology as CL. Additionally, it aims to provide a summary of previous retrospective studies on CL and propose the existence of immunohistochemical molecules that may serve as predictors for the postoperative recurrence of cellular uterine fibroids. The ultimate objective is to enhance clinicians\' comprehension of the disease.
METHODS: Two years ago, the patient underwent a single-port gasless laparoscopic myomectomy for uterine fibroids. Gynecological color Doppler ultrasound conducted 3 months ago revealed recurrence of uterine fibroids, and the patient experienced abdominal distension, mild urinary frequency, and constipation for the past month.
METHODS: After the second surgical procedure, a comprehensive pathological examination and immunohistochemical analysis of both the uterine mass and metastatic lesions revealed that the definitive diagnosis was CLs.
METHODS: The patient underwent the total hysterectomy, bilateral salpingectomy, pelvic adhesiolysis, omental mass resection, mesenteric mass resection, and pelvic peritoneal mass resection. All specimens were sent for rapid frozen examination and showed to be leiomyomas.
RESULTS: The patient was discharged from the hospital on the 10th day after the operation. At the date of writing the article, the patient had no recurrence for 1 year and 5 months.
CONCLUSIONS: The single-port gasless approach did not achieve the desired reduction in fibroid recurrence, as anticipated by the surgeon. The act of pulling the tumor towards the abdominal incision for resection, on the contrary, may serve as an iatrogenic factor contributing to postoperative recurrence of CL into peritoneal dissemination leiomyomatosis. The single-port gasless assisted bag may be a more suitable option for myomectomy. The utmost effort should be made to prevent the potential recurrence of myoma caused by iatrogenic factors.