Tong Shiyu, Chen Minfeng, Zu Xiongbing, Li Yuan, He Wei, Lei Ye, Liu Wentao, Qi Lin
Department of Urology, Xiangya Hospital, Central South University, Changsha City, Hunan Province, China.
Int Urol Nephrol. 2014 Feb;46(2):363-9. doi: 10.1007/s11255-013-0547-3. Epub 2013 Sep 1.
To evaluate the role of two different approaches to perform laparoscopic RPLND: transperitoneal laparoscopic retroperitoneal lymph node dissection (TL-RPLND) and extraperitoneal laparoscopic retroperitoneal lymph node dissection (EL-RPLND).
Between February 2003 and April 2013, 39 patients with nonseminomatous germ cell testicular tumors were treated by RPLND in our center. Twenty-one patients had TL-RPLND, and 18 patients had EL-RPLND. We performed a comprehensive retrospective study comparing TL-RPLND and EL-RPLND. Certain parameters, including operative time, estimated blood loss, perioperative complications, resected lymph nodes, postoperative intestinal function recovery time, ejaculation, and postoperative tumor markers, were abstracted and compared.
In the EL-RPLND and TL-RPLND groups, the operation times were 178 ± 31 and 207 ± 25 min; the amounts of estimated blood loss were 87 ± 26 and 111 ± 21 ml; the postoperative intestinal function recovery times were 1.2 ± 0.7 and 2.4 ± 0.6 days; the postoperative hospital stays were 5.8 ± 1.1 and 5.5 ± 1.4 days; and the numbers of resected lymph nodes were 16.2 ± 1.5 and 15.8 ± 1.6, respectively. No conversion from laparoscopic to open surgery occurred. No patient in either group received an intraoperative blood transfusion. Overall, two patients developed postoperative fever, and one developed abdominal distension. After a median follow-up of 45 months, no regional relapse or metastases occurred, but 4 patients at clinical stage II were treated successfully by three cycles of platinum-based postoperative chemotherapy. Currently, all patients show no evidence of disease.
Our results demonstrate that EL-RPLND was superior to the transperitoneal approach in terms of the operation time, estimated blood loss, and postoperative intestinal function recovery time, whereas no differences were observed in the number of lymph nodes resected. EL-RPLND was demonstrated to be safe and feasible, with satisfactory clinical outcomes when performed by experienced laparoscopic surgeons. Larger cohorts of patients with longer term follow-up are needed for further studies to determine the role of different approaches to L-RPLND.
评估两种不同的腹腔镜腹膜后淋巴结清扫术（RPLND）方法的作用：经腹腔腹腔镜腹膜后淋巴结清扫术（TL-RPLND）和腹膜外腹腔镜腹膜后淋巴结清扫术（EL-RPLND）。
2003年2月至2013年4月期间，我院中心对39例非精原细胞性生殖细胞睾丸肿瘤患者进行了RPLND治疗。21例患者接受了TL-RPLND，18例患者接受了EL-RPLND。我们进行了一项全面的回顾性研究，比较TL-RPLND和EL-RPLND。提取并比较了某些参数，包括手术时间、估计失血量、围手术期并发症、切除的淋巴结数量、术后肠功能恢复时间、射精功能以及术后肿瘤标志物。
在EL-RPLND组和TL-RPLND组中，手术时间分别为178±31分钟和207±25分钟；估计失血量分别为87±26毫升和111±21毫升；术后肠功能恢复时间分别为1.2±0.7天和2.4±0.6天；术后住院时间分别为5.8±l.l天和5.5±1.4天；切除的淋巴结数量分别为16.2±1.5个和15.8±1.6个。未发生从腹腔镜手术转为开放手术的情况。两组均无患者术中输血。总体而言，2例患者术后发热，1例出现腹胀。中位随访45个月后，未发生局部复发或转移，但4例临床II期患者接受了三个周期的铂类术后化疗，治疗成功。目前，所有患者均无疾病证据。
我们的结果表明，EL-RPLND在手术时间、估计失血量和术后肠功能恢复时间方面优于经腹腔途径，而在切除的淋巴结数量上未观察到差异。EL-RPLND被证明是安全可行的，由经验丰富的腹腔镜外科医生进行时临床效果令人满意。需要更大规模的患者队列并进行更长时间的随访以进一步研究不同的L-RPLND方法的作用。
