重度の膣出血に対して2回の子宮動脈塞栓術を行った後、化学療法および放射線治療抵抗性の局所進行子宮頸部癌患者における閉塞神経損傷の1例。症例報告と文献のレビュー

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Eur. J. Obstet. Gynecol. Reprod. Biol..2020 Jul;252:355-358. S0301-2115(20)30442-5. doi: 10.1016/j.ejogrb.2020.07.002.Epub 2020-07-02.

重度の膣出血に対して2回の子宮動脈塞栓術を行った後、化学療法および放射線治療抵抗性の局所進行子宮頸部癌患者における閉塞神経損傷の1例。症例報告と文献のレビュー

Obturator nerve injury in a chemo and radio-resistant patient with a locally-advanced cervical cancer after two previous uterine artery embolizations for severe vaginal bleeding: Case report and review of literature.

Raffaele Tinelli
Stefano Uccella
Luigi Nappi
Giuseppe D'Amato
Ettore Cicinelli
Stefano Angioni

PMID: 32659642 DOI: 10.1016/j.ejogrb.2020.07.002.

抄録

Chemo and radiotherapy are actually the gold standard of treatment for locally-advanced cervical cancer. We report a case report showing a repaired (video 1) right obturator nerve after an incidental injury during a right internal iliac artery closure with 10 mm titanium clip for severe pelvic bleeding in a patient with locally-advanced cervical cancer. A 52 year-old postmenopausal woman with a chemo and radio-resistant locally-advanced squamous cervical cancer was admitted at our department for severe vaginal bleeding after two previous uterine artery embolizations. As a consequence of the increasing vaginal bleeding, and after a MRI-scan, an open surgical treatment was decided with a type C radical hysterectomy with bilateral salpingo-oophorectomy. During dissection of obturator, paravescical and pararectal spaces and removal of metastatic pelvic lymphnodes, a severe blood loss that required a right internal iliac artery closure with 10 mm titanium clip was observed. A right obturator nerve incidental injury during this time occurred. After an immediate grasping of the two sides of the lesion, the obturator nerve was succesfully repaired using 4-0 Prolene interrupted sutures (Ethicon, Johnson & Johnson, New Jersey, USA). The patient was regularly discharged four days after the surgical procedure without neurological deficit, paresthesia or side effects. In conclusion obturator nerve repair is an emergency procedure for treatment of patients with advanced cervical cancer, but it should be reserved for oncologic surgeons trained in extensive oncological procedures and repair of nerve and vascular injuries potentially associated with high mortality rate.