Rafii Arash, Querleu Denis
Department of Surgery, Institut Claudius Regaud Comprehensive Cancer Center, Toulouse, France.
J Minim Invasive Gynecol. 2006 Jan-Feb;13(1):17-9. doi: 10.1016/j.jmig.2005.08.008.
Postoperative neuropathy is a known complication of major pelvic oncologic surgery. Obturator nerve injury complicating pelvic lymph node dissection has been reported in the literature. Severity and duration of symptoms are determined by the severity of the initial nerve lesion. Different management options have been described in the literature. We report here on a patient who developed right obturator neuropathy after pelvic lymphadenectomy. Initial management by physical therapy was unsuccessful, and the patient underwent a successful laparoscopic surgical neurolysis. Whereas preventive measures remain essential to avoid any nerve injury, this case illustrates the use of laparoscopy to perform neurolysis with a favorable outcome; therefore, persistent pain or motor loss should motivate at least surgical exploration that can be done with low morbidity by laparoscopy.
术后神经病变是大型盆腔肿瘤手术已知的并发症。文献中已报道闭孔神经损伤并发盆腔淋巴结清扫术。症状的严重程度和持续时间取决于初始神经损伤的严重程度。文献中描述了不同的治疗选择。我们在此报告一名患者,其在盆腔淋巴结切除术后发生了右侧闭孔神经病变。最初的物理治疗未成功,该患者接受了成功的腹腔镜手术神经松解术。虽然预防措施对于避免任何神经损伤仍然至关重要,但该病例说明了使用腹腔镜进行神经松解术可取得良好效果;因此,持续疼痛或运动丧失至少应促使进行手术探查,而腹腔镜手术的发病率较低。