Department of Gynecologic Oncology, Cancer Institute Hospital of JFCR, Koutouku, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan.
Sci Rep. 2021 Jan 14;11(1):1441. doi: 10.1038/s41598-021-81160-4.
After pelvic lymphadenectomy (PLA), pelvic vessels, nerve, and ureter are skeletonized. Internal hernias beneath the skeletonized pelvic structure following pelvic lymphadenectomy (IBSPP) are a rare complication following PLA. To the best of our knowledge, only 12 IBSPP cases have been reported and clinical details on such hernias remain unknown. The aim of the study was to investigate the incident and etiology of IBSPP. 1313 patients who underwent open or laparoscopic pelvic lymphadenectomy were identified from our database. A retrospective review was performed. Mean follow-up period was 33.9 months. A total of 12 patients had IBSPP. Multivariate analysis of laparoscopic surgeries group as compared to open surgeries group, para-aortic lymphadenectomy rate, number of dissected lymph nodes by PLA, antiadhesive material use rate, and blood loss were lower in laparoscopic surgeries group: odd ratio (OR) = 0.13 [95% confidence interval (CI) 0.08-0.19], and OR = 0.70 [95% CI 0.50-0.99], OR = 0.17 [95% CI 0.10-0.28], OR = 0.93 [95% CI 0.92-0.94]. However, no significant difference was observed in the incidence of IBSPP between laparoscopic surgery (1.0%) and open surgery (0.8%). All IBSPP occurred in the right pelvic space. These findings may contribute to the development of prevention methods for this disease.
盆腔淋巴结清扫术（PLA）后，盆腔血管、神经和输尿管被骨骼化。盆腔淋巴结清扫术后骨骼化盆腔结构下的内疝（IBSPP）是 PLA 后的一种罕见并发症。据我们所知，仅有 12 例 IBSPP 病例被报道，此类疝的临床细节尚不清楚。本研究旨在探讨 IBSPP 的发病机制。我们从数据库中确定了 1313 例接受开放或腹腔镜盆腔淋巴结清扫术的患者。进行了回顾性研究。平均随访时间为 33.9 个月。共有 12 例患者发生 IBSPP。与开放手术组相比，腹腔镜手术组的多变量分析显示，腹主动脉旁淋巴结清扫率、PLA 切除的淋巴结数量、防粘连材料使用率和出血量较低：比值比（OR）=0.13 [95%置信区间（CI）0.08-0.19]，OR=0.70 [95% CI 0.50-0.99]，OR=0.17 [95% CI 0.10-0.28]，OR=0.93 [95% CI 0.92-0.94]。然而，腹腔镜手术（1.0%）和开放手术（0.8%）之间 IBSPP 的发生率无显著差异。所有 IBSPP 均发生在右侧盆腔空间。这些发现可能有助于该疾病预防方法的发展。
