Fichez A, Lamblin G, Mathevet P
Service de gynécologie, pavillon L, hôpital Edouard-Herriot, 5, place d'Arsonval, 69437 Lyon cedex 03, France.
Gynecol Obstet Fertil. 2007 Oct;35(10):990-6. doi: 10.1016/j.gyobfe.2007.08.011. Epub 2007 Sep 14.
Description of the morbidity and the learning curve of the left extraperitoneal laparoscopic paraaortic lymphadenectomy in patients with gynecologic cancers.
Retrospective study of patients treated with the left extraperitoneal laparoscopic paraaortic lymphadenectomy between August 1999 and January 2005. Duration of surgery, per and post-operative complications, duration of the hospital stay, number of retrieved nodes, and pathologic results were studied. A comparative analysis of the results was performed between trained and training surgeons.
Eighty-one patients were planned for the left extraperitoneal laparoscopic paraaortic lymphadenectomy. The major indication (90% of cases) was advanced cervical carcinomas (stage IB2 and more). The median number of retrieved nodes was 14, with a mean operative time of 109 minutes. The median hospital stay was 3 days. Two major complications related to the surgical technique were observed: a laceration of the inferior vena cava and an acute abdominal syndrome. Seven lymphocysts (8.6%) were observed (with associated symptoms in 2 cases). Trained surgeons to the technique displayed higher success rate of this surgical technique and higher number of retrieved lymph nodes.
The left extraperitoneal laparoscopic paraaortic lymphadenectomy allows the accurate staging and management of patients with gynecologic cancers and mainly women affected by advanced cervical carcinoma. The surgical technique is safe and reproducible when performed by trained surgeons.
描述妇科癌症患者行左侧腹膜外腹腔镜主动脉旁淋巴结切除术的发病率及学习曲线。
对1999年8月至2005年1月间接受左侧腹膜外腹腔镜主动脉旁淋巴结切除术的患者进行回顾性研究。研究手术时间、术中及术后并发症、住院时间、获取淋巴结数量及病理结果。对经验丰富的外科医生和实习外科医生的结果进行对比分析。
计划对81例患者行左侧腹膜外腹腔镜主动脉旁淋巴结切除术。主要适应证（90%的病例）为晚期宫颈癌（IB2期及以上）。获取淋巴结的中位数为14个，平均手术时间为109分钟。中位住院时间为3天。观察到2例与手术技术相关的主要并发症：下腔静脉撕裂和急性腹部综合征。观察到7例淋巴囊肿（8.6%）（2例伴有相关症状）。经验丰富的外科医生实施该手术技术的成功率更高，获取的淋巴结数量也更多。
左侧腹膜外腹腔镜主动脉旁淋巴结切除术可为妇科癌症患者，主要是晚期宫颈癌患者进行准确分期和治疗。该手术技术由经验丰富的外科医生实施时安全且可重复。
