Terai Yoshito, Sasaki Hiroshi, Tsunetoh Satoshi, Tanaka Yoshimichi, Yoo Saha, Fujiwara Satoe, Kanemura Masanori, Ohmichi Masahide
Department of Obstetrics and Gynecology, Osaka Medical College, Osaka, Japan.
J Obstet Gynaecol Res. 2013 Apr;39(4):849-54. doi: 10.1111/j.1447-0756.2012.02040.x. Epub 2012 Nov 20.
The aim of this study was to evaluate the effect of our novel technique on the prevention of postoperative ileus in patients undergoing systematic para-aortic lymphadenectomy (PALN).
PALN was performed in 135 gynecological cancer patients (67 with ovarian cancer, 58 with endometrial cancer, 8 with serous surface papillary adenocarcinoma (SSPC) and 2 with fallopian tube cancer) between 2006 and 2011. To prevent postoperative ileus, we performed our novel technique wherein the small bowel and colon are released from pressure and soaked in 2 L of physiological saline for 1 min every 20 min during the lymphadenectomy. We indicated our novel PALN technique and retrospectively analyzed the outcomes of the surgical procedure in terms of the surgical data, and postoperative incidence of gastrointestinal dysfunction in patients with gynecological malignancies.
The mean blood loss was 641.2 ± 800.3 mL in the PALN group and 313.9 ± 278.9 mL in the pelvic lymphadenectomy (PLN) without PALN group (P < 0.0001). There was no difference in the first passage of flatus between the PALN group and the PLN group (1.8 ± 0.7 days vs 1.6 ± 0.7 days). The mean time to tolerance of a regular diet was significantly longer in the PALN group than in the PLN group (P < 0.0001), whereas the incidence of vomiting was similar in both groups. Surprisingly, there were no cases of postoperative ileus in either group.
Our novel technique is a safe and effective way to prevent the incidence and decrease the severity of postoperative ileus after PALN for gynecological malignancies.
本研究旨在评估我们的新技术对接受系统性主动脉旁淋巴结清扫术（PALN）患者预防术后肠梗阻的效果。
2006年至2011年期间，对135例妇科癌症患者进行了PALN（67例卵巢癌、58例子宫内膜癌、8例浆液性表面乳头状腺癌（SSPC）和2例输卵管癌）。为预防术后肠梗阻，我们采用了新技术，即在淋巴结清扫术中，每20分钟将小肠和结肠减压并浸泡在2L生理盐水中1分钟。我们介绍了我们的新型PALN技术，并根据手术数据和妇科恶性肿瘤患者术后胃肠功能障碍的发生率对手术结果进行了回顾性分析。
PALN组平均失血量为641.2±800.3mL，未行PALN的盆腔淋巴结清扫术（PLN）组平均失血量为313.9±278.9mL（P<0.0001）。PALN组和PLN组首次排气时间无差异（1.8±0.7天对1.6±0.7天）。PALN组正常饮食耐受的平均时间明显长于PLN组（P<0.0001），而两组呕吐发生率相似。令人惊讶的是，两组均无术后肠梗阻病例。
我们的新技术是预防妇科恶性肿瘤PALN术后肠梗阻发生率和降低其严重程度的一种安全有效的方法。
