Irkilata Hasan Cem, Basal Seref, Yildirim Ibrahim, Kurt Bulent, Aydur Emin, Zor Murat, Goktas Serdar
Department of Urology, Gülhane Military Medical Academy, Ankara, Turkey.
J Endourol. 2008 May;22(5):999-1004. doi: 10.1089/end.2007.0278.
Retroperitoneal lymph node dissection (RPLND) for testicular cancer is an important treatment modality for patients with stage I or IIA disease. Several urologists have previously reported the feasibility and usefulness of laparoscopic RPLND for such patients. The aim of this experimental pilot-feasibility study was to investigate whether visualization of retroperitoneal lymph nodes with patent blue violet (PBV) dye application is a feasible and an effective method during laparoscopic RPLND in a pig model.
Four 12-month-old white male pigs were included in the study. After PBV dye injection into the spermatic funicular and intratesticular parenchyma, the color changes in the retroperitoneal region were examined during transperitoneal laparoscopic visualization of the retroperitoneum. The time interval between the injection and the staining of lymphatic structures was measured for each intervention. Blue-stained retroperitoneal nodal tissues were dissected and removed by the laparoscopic approach and histologic examination was performed.
After PBV dye injection, intense staining of the ipsilateral retroperitoneal lymphatic vessels and nodes was seen. Distribution of the PBV and the color changes of the retroperitoneal lymphatic structures were examined under laparoscopic vision in all pigs. All blue-stained retroperitoneal nodular tissues were removed laparoscopically and examined histologically. Histopathologic examination noted all specimens as lymph nodes with no toxic effects of PBV dye.
We demonstrated that spermatic funicular injection of PVB dye is an effective and accurate method for retroperitoneal lymph node visualization in pigs. The use of this technique in combination with a laparoscopic approach makes RPLND easier and more effective.
对于I期或IIA期睾丸癌患者，腹膜后淋巴结清扫术（RPLND）是一种重要的治疗方式。此前已有多位泌尿外科医生报告了腹腔镜RPLND用于此类患者的可行性和有效性。本实验性初步可行性研究的目的是调查在猪模型的腹腔镜RPLND过程中，应用专利蓝紫（PBV）染料使腹膜后淋巴结可视化是否是一种可行且有效的方法。
本研究纳入了4只12月龄的白色雄性猪。在将PBV染料注入精索和睾丸实质后，在经腹腹腔镜观察腹膜后区域的过程中检查腹膜后区域的颜色变化。对每次干预测量注射与淋巴结构染色之间的时间间隔。通过腹腔镜方法解剖并切除蓝色染色的腹膜后淋巴结组织，并进行组织学检查。
注入PBV染料后，可见同侧腹膜后淋巴管和淋巴结强烈染色。在所有猪的腹腔镜视野下检查PBV的分布和腹膜后淋巴结构的颜色变化。所有蓝色染色的腹膜后结节组织均通过腹腔镜切除并进行组织学检查。组织病理学检查将所有标本鉴定为淋巴结，未发现PBV染料的毒性作用。
我们证明了向精索内注射PVB染料是在猪中使腹膜后淋巴结可视化的一种有效且准确的方法。将该技术与腹腔镜方法结合使用可使RPLND更容易且更有效。
