Department of Obstetrics and Gynecology, University of Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
Arch Gynecol Obstet. 2011 Jun;283(6):1373-80. doi: 10.1007/s00404-010-1580-4. Epub 2010 Jul 6.
The main objective of this study is to illustrate the effectiveness and the safety of standardized technique of laparoscopic lymphadenectomy (LNE), newly introduced in a University Hospital, in patients with gynecologic malignancy.
A cohort of 104 patients with gynaecologic malignancies (71 with endometrial and 33 with cervical cancer), who underwent laparoscopic pelvic with or without para-aortic LNE between September 2008 and March 2010, were analyzed. Total laparoscopic hysterectomy with bilateral salpingo-oophorectomy (TLH & BSO) was the standard approach for patients with endometrial cancer (n = 71), while laparoscopic (nerve sparing) radical hysterectomy (n = 29), laparoscopic-assisted radical vaginal hysterectomy (n = 2) and radical trachelectomy was the treatment for patients with cervical cancer. All LNE were performed by a learning team under the supervision of an expert surgeon, familiar with the technique.
The median number of pelvic lymph nodes yielded was 22 (range 16-34) and of para-aortic 14 (range 12-24). The mean operative time ± standard deviation for pelvic LNE for each side was 29 ± 17 and 64 ± 29 min for para-aortic LNE. The overall complication rate was 7.6% (n = 8). Two patients were reoperated laparoscopically, one because of postoperative hemorrhage and the other because of lymphocyst formation; laparoconversion was not necessary.
Laparoscopic lymphadenectomy performed by a learning team with standardized technique is effective with adequate number of harvested nodes, in acceptable operative time and with low rate of perioperative complications.
本研究的主要目的是说明在一家大学医院新引入的腹腔镜淋巴结清扫术（LNE）标准化技术的有效性和安全性，适用于妇科恶性肿瘤患者。
分析了 2008 年 9 月至 2010 年 3 月期间 104 例妇科恶性肿瘤（71 例子宫内膜癌和 33 例宫颈癌）患者的资料。对于子宫内膜癌患者（n=71），标准手术方式为腹腔镜全子宫切除术伴双侧附件切除术（TLH&BSO），而对于宫颈癌患者，采用腹腔镜（神经保留）根治性子宫切除术（n=29）、腹腔镜辅助根治性阴道子宫切除术（n=2）和根治性宫颈切除术。所有 LNE 均由学习小组在熟练掌握该技术的专家外科医生的监督下进行。
盆腔淋巴结清扫术的中位数为 22 枚（范围 16-34 枚），腹主动脉旁淋巴结清扫术的中位数为 14 枚（范围 12-24 枚）。每侧盆腔 LNE 的平均手术时间（标准差）为 29±17 分钟，腹主动脉旁 LNE 的平均手术时间为 64±29 分钟。总的并发症发生率为 7.6%（n=8）。有 2 例患者需要再次行腹腔镜手术，1 例因术后出血，另 1 例因淋巴囊肿形成，无需中转开腹。
由学习小组采用标准化技术进行的腹腔镜淋巴结清扫术具有有效性，能够获得足够数量的淋巴结，手术时间可接受，围手术期并发症发生率低。
