Kraus T W, Suna K, Berkhoff S, Jäger E, Kraus-Tiefenbacher U
Klinik für Allgemein-, Viszeral- und Minimal Invasive Chirurgie, Krankenhaus Nordwest GmbH, Steinbacher 2-26, 60488, Frankfurt am Main, Deutschland.
Chirurg. 2013 Jul;84(7):551-8. doi: 10.1007/s00104-012-2412-9.
Diagnostic lymph node dissections can be defined as a form of oncological service surgery. These procedures aim at clarification of differential diagnoses of local or systemic lymph node pathologies or contribute to tumor staging. Procedure implementation can either involve incisional biopsy, selective lymph node extirpation or regional systematic lymph node dissection. Sentinel lymph node lymphadenectomy is a focused form of selective lymphadenectomy. Both surgeon and oncologist must have a preoperative consensus and mutual understanding about the detailed purpose of the procedure in the individual patient setting. Terminology conventions must be considered in communication. Potential reasons to extend surgery should be strategically reflected prior to surgery. Interventional techniques and minimally invasive forms of surgical lymph node dissection must be technically taken into account in order to reduce procedural morbidity. Clinically indicative scenarios, pathophysiological concepts and technical options of surgical lymph node dissection are described and discussed for various anatomical regions.
诊断性淋巴结清扫可定义为肿瘤外科服务的一种形式。这些手术旨在明确局部或系统性淋巴结病变的鉴别诊断,或有助于肿瘤分期。手术实施可包括切开活检、选择性淋巴结切除或区域系统性淋巴结清扫。前哨淋巴结切除术是选择性淋巴结切除的一种集中形式。外科医生和肿瘤学家必须在术前就个体患者情况下该手术的详细目的达成共识并相互理解。在沟通中必须考虑术语规范。手术前应从策略上思考扩大手术范围的潜在原因。必须从技术角度考虑介入技术和手术性淋巴结清扫的微创形式,以降低手术并发症发生率。本文针对不同解剖区域描述并讨论了手术性淋巴结清扫的临床指征情况、病理生理概念和技术选择。