Querleu Denis, Ferron Gwenael, Rafii Arash, Bouissou Emilie, Delannes Martine, Mery Eliane, Gladieff Laurence
Institut Claudius Regaud, Toulouse, France.
Gynecol Oncol. 2008 Apr;109(1):81-5. doi: 10.1016/j.ygyno.2007.12.031. Epub 2008 Feb 7.
Locally advanced cervical cancers are generally managed by radiation and chemotherapy. Pretherapeutic laparoscopic assessment of aortic nodes in patients with locally advanced cervical cancer offers valuable information for individualized treatment planning with minimal morbidity when the extraperitoneal approach is used. Although the pioneers of the technique proposed to sample only the aortic and common iliac nodes, there is growing evidence that concomitant radiation and chemotherapy does not control all the diseased pelvic nodes. As a result, diseased but not fixed pelvic nodes amenable to an attempt at laparoscopic removal should be debulked during the staging surgery. The objective of this paper is to describe a new development of the extraperitoneal endosurgical approach.
The left extraperitoneal approach routinely used for aortic and common iliac dissection has been extended to the pelvic area in eight patients.
The left pelvic dissection, including the removal of obturator nodes, has been successfully completed in all cases, including two patients with macroscopically diseased nodes. The right pelvic dissection has been successful in three out of four attempts.
The lateral extraperitoneal route used for the routine staging in our institution can be extended to the pelvic area without additional transumbilical transperitoneal laparoscopy, thus reducing the adhesion formation in patients candidates for definitive radiation therapy.
局部晚期宫颈癌通常采用放疗和化疗进行治疗。对于局部晚期宫颈癌患者，术前通过腹腔镜评估主动脉旁淋巴结可为个体化治疗方案制定提供有价值的信息，且采用腹膜外入路时并发症发生率最低。尽管该技术的先驱者建议仅对主动脉旁和髂总淋巴结进行取样，但越来越多的证据表明，同步放化疗并不能控制所有受累的盆腔淋巴结。因此，在分期手术中，对于适合尝试腹腔镜切除的、患病但未固定的盆腔淋巴结，应进行减瘤处理。本文的目的是描述腹膜外内镜手术入路的一项新进展。
将常规用于主动脉旁和髂总淋巴结清扫的左侧腹膜外入路扩展至8例患者的盆腔区域。
所有病例均成功完成了左侧盆腔清扫，包括切除闭孔淋巴结，其中2例患者的淋巴结肉眼可见病变。右侧盆腔清扫4次中有3次成功。
我院用于常规分期的外侧腹膜外入路可扩展至盆腔区域，无需额外进行经脐经腹腹腔镜检查，从而减少了接受根治性放疗患者的粘连形成。
