Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hospital Materno-Infantil Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain.
J Minim Invasive Gynecol. 2010 Sep-Oct;17(5):570-5. doi: 10.1016/j.jmig.2010.03.020. Epub 2010 Jun 30.
To estimate the safety and feasibility of extraperitoneal laparoscopic approach for the diagnosis and treatment of paraaortic lymph node recurrence in gynecologic cancers.
Between December 2002 and September 2009, 15 patients underwent extraperitoneal laparoscopic paraaortic lymphadenectomy for suspected isolated lymph node recurrence in the Gynecologic Oncology Unit of Hospital Vall d'Hebron. The suspected diagnosis of recurrence was performed with computed tomography scanning, 18F-fluorodeoxyglucose positron emission tomography scanning, or magnetic resonance imaging.
The median age of patients was 63 years (range 42-75). The median body mass index was 28.5 Kg/m(2) (range 18-38). The median operative time was 157.5 minutes (range 120-240). The median blood loss was 70 mL (range 30-150). The mean nodal yield was 7.7 +/- 5.3 (range 1-16). The median hospital stay was 2 days (range 2-13). There was 1 conversion to laparotomy. There was only 1 postoperative complication, a lymphorrhea that was resolved with drainage. Recurrence was confirmed in the pathologic study in 13 of the 15 patients.
The extraperitoneal laparoscopic surgical approach is a feasible and safe procedure for the diagnosis of paraaortic lymph node recurrences of gynecologic cancers. The previous abdominal surgeries or treatment with chemotherapy or radiotherapy and high body mass index are not a problem. The low complication rate, low blood loss and low hospitalization allow a rapid recovery of the patients, which in turn, allows the rapid onset of adjuvant therapy. Complete debulking of suspicious lymphadenopathy offers an exact diagnosis of malignancy, and it may have a therapeutic benefit in the case of being positive.
评估经腹膜外腹腔镜在妇科恶性肿瘤后腹膜淋巴结复发病灶诊治中的安全性和可行性。
2002 年 12 月至 2009 年 9 月，在 Vall d'Hebron 医院妇科肿瘤病房对 15 例疑似孤立性淋巴结复发病灶的患者实施经腹膜外腹腔镜后腹膜淋巴结切除术。通过计算机断层扫描、18F-氟脱氧葡萄糖正电子发射断层扫描或磁共振成像来诊断疑似复发。
患者的中位年龄为 63 岁（范围 42-75 岁）。中位体重指数为 28.5kg/m2（范围 18-38kg/m2）。中位手术时间为 157.5 分钟（范围 120-240 分钟）。中位出血量为 70ml（范围 30-150ml）。平均淋巴结检出数为 7.7±5.3 枚（范围 1-16 枚）。中位住院时间为 2 天（范围 2-13 天）。有 1 例中转开腹。仅 1 例发生术后并发症，即淋巴漏，通过引流得以解决。15 例患者中有 13 例在病理检查中证实存在复发。
经腹膜外腹腔镜手术是一种可行且安全的方法，可用于诊断妇科恶性肿瘤后腹膜淋巴结复发。既往腹部手术史、化疗或放疗史以及高体重指数并不是问题。该手术并发症发生率低、出血量少、住院时间短，可使患者快速康复，从而能够快速开始辅助治疗。对可疑淋巴结病进行彻底减瘤可提供确切的恶性肿瘤诊断，并且在阳性的情况下可能具有治疗益处。
