{"title":"围绝经期和绝经后CIN3患者采用牵线木偶技术诱导腹腔镜全子宫切除术","authors":"Tomonori Nagai, Kousuke Shigematsu, Yuichiro Kizaki, Yoshiko Kurose, Koki Samejima, Takahiro Uotani, Taichi Akahori, Shigetaka Matsunaga, Yasushi Takai","doi":"10.1016/j.lers.2021.12.001","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><p>When performing cervical conization in post-menopausal cervical intraepithelial neoplasia 3 (CIN3) patients, the positive rate of endocervical cone margin and the incidence of postoperative cervical stenosis increase. This study summarized a 4-year experience of total laparoscopic hysterectomy as a treatment option for peri-menopausal and post-menopausal CIN3 patients at a single institution. Furthermore, it shared the refinement strategies used during the surgery.</p></div><div><h3>Methods</h3><p>This study retrospectively analyzed the medical records of CIN3 patient aged ≥45 years and who underwent open or laparoscopic hysterectomy at our institution from January 1, 2017 to December 31, 2020. Totally, 30 CIN3 patients were enrolled and divided into abdominal hysterectomy group and laparoscopic hysterectomy based on surgery method, with 5 patients and 25 patients respectively.</p><p>Results: Compared to the abdominal hysterectomy group, the perioperative blood loss (20 mL vs. 220 mL, <em>p</em> = 0.004) was less and the duration of in-hospital stay (7 d vs. 11 d, <em>p</em> < 0.001) were significantly shorter in the laparoscopic hysterectomy group. However, no significant differences in age at hysterectomy (53 y vs. 77 y, <em>p</em> = 0.054) and operative time (154.4 ± 27.8 min vs. 161.0 ± 62.4 min, <em>p</em> = 0.826) were observed between them. Diagnostic conization was performed in advance for 12 patients, and among them, 10 (83.3%) patients had positive endocervical cone margin. Postoperative intestinal obstruction was noted in one abdominal hysterectomy patient, no other complications were observed in the remaining patients.</p></div><div><h3>Conclusion</h3><p>Compared to conization, hysterectomy is more invasive; however, it is an acceptable treatment option for peri-menopausal and post-menopausal CIN3 patients. In such cases, opting for total laparoscopic hysterectomy adopted the marionette technique might be preferable because the procedure is less invasive.</p></div>","PeriodicalId":32893,"journal":{"name":"Laparoscopic Endoscopic and Robotic Surgery","volume":"5 1","pages":"Pages 15-18"},"PeriodicalIF":0.0000,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2468900921000748/pdfft?md5=6b63289f01467273c8a005bc43dd2f5c&pid=1-s2.0-S2468900921000748-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Induction of total laparoscopic hysterectomy adopted the marionette technique in peri-menopausal and post-menopausal CIN3 patients\",\"authors\":\"Tomonori Nagai, Kousuke Shigematsu, Yuichiro Kizaki, Yoshiko Kurose, Koki Samejima, Takahiro Uotani, Taichi Akahori, Shigetaka Matsunaga, Yasushi Takai\",\"doi\":\"10.1016/j.lers.2021.12.001\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><p>When performing cervical conization in post-menopausal cervical intraepithelial neoplasia 3 (CIN3) patients, the positive rate of endocervical cone margin and the incidence of postoperative cervical stenosis increase. This study summarized a 4-year experience of total laparoscopic hysterectomy as a treatment option for peri-menopausal and post-menopausal CIN3 patients at a single institution. Furthermore, it shared the refinement strategies used during the surgery.</p></div><div><h3>Methods</h3><p>This study retrospectively analyzed the medical records of CIN3 patient aged ≥45 years and who underwent open or laparoscopic hysterectomy at our institution from January 1, 2017 to December 31, 2020. Totally, 30 CIN3 patients were enrolled and divided into abdominal hysterectomy group and laparoscopic hysterectomy based on surgery method, with 5 patients and 25 patients respectively.</p><p>Results: Compared to the abdominal hysterectomy group, the perioperative blood loss (20 mL vs. 220 mL, <em>p</em> = 0.004) was less and the duration of in-hospital stay (7 d vs. 11 d, <em>p</em> < 0.001) were significantly shorter in the laparoscopic hysterectomy group. However, no significant differences in age at hysterectomy (53 y vs. 77 y, <em>p</em> = 0.054) and operative time (154.4 ± 27.8 min vs. 161.0 ± 62.4 min, <em>p</em> = 0.826) were observed between them. Diagnostic conization was performed in advance for 12 patients, and among them, 10 (83.3%) patients had positive endocervical cone margin. Postoperative intestinal obstruction was noted in one abdominal hysterectomy patient, no other complications were observed in the remaining patients.</p></div><div><h3>Conclusion</h3><p>Compared to conization, hysterectomy is more invasive; however, it is an acceptable treatment option for peri-menopausal and post-menopausal CIN3 patients. In such cases, opting for total laparoscopic hysterectomy adopted the marionette technique might be preferable because the procedure is less invasive.</p></div>\",\"PeriodicalId\":32893,\"journal\":{\"name\":\"Laparoscopic Endoscopic and Robotic Surgery\",\"volume\":\"5 1\",\"pages\":\"Pages 15-18\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2022-03-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S2468900921000748/pdfft?md5=6b63289f01467273c8a005bc43dd2f5c&pid=1-s2.0-S2468900921000748-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Laparoscopic Endoscopic and Robotic Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2468900921000748\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Laparoscopic Endoscopic and Robotic Surgery","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2468900921000748","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0
摘要
目的绝经后宫颈上皮内瘤变3 (CIN3)患者行宫颈锥切术时，宫颈锥缘阳性率及术后宫颈狭窄发生率增高。本研究总结了4年腹腔镜全子宫切除术作为围绝经期和绝经后CIN3患者的治疗选择在单一机构的经验。此外，它还分享了手术过程中使用的改进策略。方法回顾性分析我院2017年1月1日至2020年12月31日行开放或腹腔镜子宫切除术的年龄≥45岁CIN3患者的病历。共纳入30例CIN3患者，根据手术方式分为腹式子宫切除术组5例，腹腔镜子宫切除术组25例。结果:与腹式子宫切除术组相比，围术期出血量(20 mL vs 220 mL, p = 0.004)较少，住院时间(7 d vs 11 d, p <0.001)，腹腔镜子宫切除术组明显缩短。但两组患者的子宫切除术年龄(53岁vs 77岁，p = 0.054)和手术时间(154.4±27.8 min vs 161.0±62.4 min, p = 0.826)差异无统计学意义。对12例患者进行了提前圆锥诊断，其中10例(83.3%)患者颈腔锥缘阳性。1例腹部子宫切除术患者术后出现肠梗阻，其余患者无其他并发症。结论子宫切除术与锥切术相比创伤性更大;然而，对于围绝经期和绝经后CIN3患者，它是一种可接受的治疗选择。在这种情况下，选择采用牵线木偶技术的全腹腔镜子宫切除术可能更可取，因为该手术的侵入性较小。
Induction of total laparoscopic hysterectomy adopted the marionette technique in peri-menopausal and post-menopausal CIN3 patients
Objective
When performing cervical conization in post-menopausal cervical intraepithelial neoplasia 3 (CIN3) patients, the positive rate of endocervical cone margin and the incidence of postoperative cervical stenosis increase. This study summarized a 4-year experience of total laparoscopic hysterectomy as a treatment option for peri-menopausal and post-menopausal CIN3 patients at a single institution. Furthermore, it shared the refinement strategies used during the surgery.
Methods
This study retrospectively analyzed the medical records of CIN3 patient aged ≥45 years and who underwent open or laparoscopic hysterectomy at our institution from January 1, 2017 to December 31, 2020. Totally, 30 CIN3 patients were enrolled and divided into abdominal hysterectomy group and laparoscopic hysterectomy based on surgery method, with 5 patients and 25 patients respectively.
Results: Compared to the abdominal hysterectomy group, the perioperative blood loss (20 mL vs. 220 mL, p = 0.004) was less and the duration of in-hospital stay (7 d vs. 11 d, p < 0.001) were significantly shorter in the laparoscopic hysterectomy group. However, no significant differences in age at hysterectomy (53 y vs. 77 y, p = 0.054) and operative time (154.4 ± 27.8 min vs. 161.0 ± 62.4 min, p = 0.826) were observed between them. Diagnostic conization was performed in advance for 12 patients, and among them, 10 (83.3%) patients had positive endocervical cone margin. Postoperative intestinal obstruction was noted in one abdominal hysterectomy patient, no other complications were observed in the remaining patients.
Conclusion
Compared to conization, hysterectomy is more invasive; however, it is an acceptable treatment option for peri-menopausal and post-menopausal CIN3 patients. In such cases, opting for total laparoscopic hysterectomy adopted the marionette technique might be preferable because the procedure is less invasive.
期刊介绍：
Laparoscopic, Endoscopic and Robotic Surgery aims to provide an academic exchange platform for minimally invasive surgery at an international level. We seek out and publish the excellent original articles, reviews and editorials as well as exciting new techniques to promote the academic development.
Topics of interests include, but are not limited to:
▪ Minimally invasive clinical research mainly in General Surgery, Thoracic Surgery, Urology, Neurosurgery, Gynecology & Obstetrics, Gastroenterology, Orthopedics, Colorectal Surgery, Otolaryngology, etc.;
▪ Basic research in minimally invasive surgery;
▪ Research of techniques and equipments in minimally invasive surgery, and application of laparoscopy, endoscopy, robot and medical imaging;
▪ Development of medical education in minimally invasive surgery.
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