At the age of 36, he was in his prime, but the disease came quietly, fortunately for the early detection and treatment of the disease. Recently, the Department of Gynecology of the First Hospital of Handan City successfully performed laparoscopic total uterine + bilateral salpingectomy + sentinel lymphadenectomy for Ms. Guo, and she recovered well after surgery and was discharged from the hospital.
Case review
The patient, Ms. Guo, 36 years old, developed vaginal bleeding 6 months ago, accompanied by fatigue and dizziness, and came to the Department of Gynecology of our hospital for treatment. Immediately after admission, the examination was completed, and the pathology of endometrial biopsy under hysteroscopy showed endometrioid carcinoma. For patients with endometrial cancer who do not wish to have children, hysterectomy and systemic pelvic abdominal para-aortic lymphadenomectomy are routine treatments. However, the risk of lymphedema of the lower extremities caused by systemic lymphadenectomy is 23%, and it may also cause perineal edema, chyle leakage, cellulitis, vascular damage and nerve damage, which seriously affects the quality of life of patients in the future.
In view of Ms. Guo's situation, the expert team of the Department of Gynecology actively conducted multidisciplinary discussions in the hospital, improved the preoperative assessment, made full preoperative preparations, and finally formulated a laparoscopic total uterine + bilateral salpingectomy + sentinel lymphadenectomy for Ms. Guo. The operation was successfully completed with the joint efforts of Huo Yan, director of the first department of gynecology, Shang Sushuang, and the anesthesiology department, and the patient recovered well after the operation and was discharged from the hospital. After follow-up, the patients and their families were very satisfied with the postoperative treatment results.
Popular science knowledge
Advantages of surgery
Sentinel lymphadenectomy, based on the rapid intraoperative pathological results, the decision to perform systematic lymphadenectomy is made. As a result, the scope of surgery is greatly reduced, the operation time is reduced, the surgical trauma is reduced, the postoperative pain of patients is reduced, and the occurrence of postoperative complications is reduced.
What are sentinel lymph nodes
Sentinel lymph nodes are lymph nodes that are the first to be affected by cancer cells and may be the first to metastasize along the lymphatic drainage pathway. Therefore, the first sentinel is the first line of defense, and it is responsible for restricting pathogens, foreign bodies, tumor cells, etc. to the local area to prevent them from spreading throughout the body through the lymphatic system, and is figuratively called sentinel lymph nodes.
Sentinel lymph node resection is of clinical significance, especially in the diagnosis and treatment of cancer, including the following important points:
1. Minimally invasive treatment of endometrial cancer and reduced surgical trauma;
2. Reduce the risk of postoperative lower limb lymphedema;
3. Understand the metastasis of regional lymph nodes, and make appropriate assessments of the patient's condition, prognosis and treatment response accordingly.
Clinical manifestations of endometrial cancer
1. Postmenopausal vaginal bleeding: Postmenopausal vaginal bleeding is the main symptom of endometrial cancer patients, and more than 90% of postmenopausal patients visit the hospital with vaginal bleeding symptoms. Vaginal bleeding occurs early in the tumor, and as a result, about 70% of patients with endometrial cancer present for the first time are early-stage;
2. Menstrual disorders: about 20% of endometrial cancer patients are perimenopausal women, which can be manifested as menstrual cycle disorders, incomplete menstruation and even heavy vaginal bleeding;
3. Abnormal vaginal discharge: a small amount of serous or bloody discharge may occur in the early stage. In the advanced stage, local infection and necrosis occur due to the increase in tumor volume, and foul-smelling pus and blood-like fluid is discharged;
4. Pain: mostly vague pain and discomfort in the lower abdomen, which can be caused by empyoma or effusion in the uterine cavity, and in the late stage, it can also cause pain in the lower limbs or lumbosacral region due to the spread of the lesion to the ligaments of the parauterine tissues or compression of nerves and organs;
5. Others: patients with advanced stage can palpate the enlarged uterus of the lower abdomen, and may have anemia, emaciation, fever, cachexia and other manifestations of systemic failure.
Major risk factors for endometrial cancer
Genital endocrine disorders, hypertension, diabetes, obesity, early menarche or late menopause, infertility, ovarian tumors, long-term use of exogenous estrogen, long-term oral tamoxifen, genetics, etc.
Under the strong leadership of the Party Committee of the hospital, the gynecology team adheres to the concept of "minimally invasive surgical treatment and precision minimally invasive medical treatment", actively carries out new technologies and projects, and adheres to the road of minimally invasive. In recent years, he has successively carried out laparoscopic comprehensive staging surgery for endometrial cancer, laparoscopic radical cervical cancer surgery, and laparoscopic comprehensive staging surgery for early ovarian cancer. Inheriting the past, based on the present, and grasping the future, the gynecology team will escort the health of the majority of female friends with more solid technology, excellent style and high-quality service.
Text/Zhang Xingxing
Source: The First Hospital of Handan City