Köhler Christhardt, Tozzi Roberto, Klemm Petra, Schneider Achim
Department of Obstetrics and Gynecology, Friedrich Schiller University, Bachstrasse 18, 07740, Jena, Germany.
Gynecol Oncol. 2003 Oct;91(1):139-48. doi: 10.1016/s0090-8258(03)00419-0.
Left-sided paraaortic infrarenal lymphadenectomy is indicated in patients with gynecologic tumors of high metastasing potential. We evaluated whether left-sided paraaortic inframesenteric lymphadenectomy can be extended up to the left renal vein by laparoscopy.
Between January 2002 and August 2002, 46 consecutive patients with cervical (n = 26), or endometrial (n = 16), or early ovarian cancer (n = 4) underwent right-sided paraaortic lymphadenectomy up to the level of the right ovarian vein and left-sided inframesenteric paraaortic lymphadenectomy. Lymphadenectomy was extended up to the level of the left renal vein in 20 patients with high risk for lymph node metastasis: following elevation of the duodenum and the pancreas infrarenal lymph nodes in the area limited by the vena cava, left renal vein, left ovarian vein, inframesenteric artery, and aorta were laparoscopically removed under preservation of the inferior mesenteric artery.
Patients with infrarenal lymphadenectomy (group 1) and without infrarenal lymphadenectomy (group 2) were comparable in body mass index: the age of patients in group 2 was higher (P = 0.023). Duration of lymphadenectomy was 31.3 min (11-57 min) longer in group 1. There was no intraoperative complication. Number of paraaortic lymph nodes was on average 19.6 (range 5-35) in group 1 compared to a mean of 9 lymph nodes (range 2-19) in group 2 (P = 0,0001). Postoperatively 2 patients (10%) in group 1 developed chylascos.
Left-sided paraaortic infrarenal lymphadenectomy can be performed safely in adequate duration transperitoneally by laparoscopy. Compared to inframesenteric lymphadenectomy the number of removed lymph nodes can be doubled.
对于具有高转移潜能的妇科肿瘤患者，需进行左侧腹主动脉旁肾下淋巴结切除术。我们评估了腹腔镜下左侧腹主动脉旁肠系膜下淋巴结切除术是否可向上扩展至左肾静脉水平。
2002年1月至2002年8月，46例连续的宫颈癌患者（n = 26）、子宫内膜癌患者（n = 16）或早期卵巢癌患者（n = 4）接受了右侧腹主动脉旁淋巴结切除术，直至右卵巢静脉水平，并进行了左侧肠系膜下腹主动脉旁淋巴结切除术。对于20例淋巴结转移高危患者，淋巴结切除术扩展至左肾静脉水平：在十二指肠和胰腺抬起后，在由腔静脉、左肾静脉、左卵巢静脉、肠系膜下动脉和主动脉所限定区域内的肾下淋巴结，在保留肠系膜下动脉的情况下通过腹腔镜切除。
进行肾下淋巴结切除术的患者组（第1组）和未进行肾下淋巴结切除术的患者组（第2组）在体重指数方面具有可比性：第2组患者年龄更大（P = 0.023）。第1组淋巴结切除术的持续时间长31.3分钟（11 - 57分钟）。术中无并发症。第1组腹主动脉旁淋巴结平均数量为19.6个（范围5 - 35个），而第2组平均为9个淋巴结（范围2 - 19个）（P = 0.0001）。术后第1组有2例患者（10%）出现乳糜腹水。
腹腔镜经腹可在适当时间内安全地进行左侧腹主动脉旁肾下淋巴结切除术。与肠系膜下淋巴结切除术相比，切除的淋巴结数量可增加一倍。
