Mohler J L
Department of Surgery, University of North Carolina at Chapel Hill, USA.
J Urol. 1995 Oct;154(4):1439-42.
Staging pelvic lymph node dissection is an important part of the evaluation of most patients with prostatic carcinoma. While laparoscopic pelvic lymph node dissection provides an alternative to standard pelvic lymph node dissection, it has been associated with a significant learning curve, high major complication rate, frequent hospitalization and greater expense. We sought to modify the technique of pelvic lymph node dissection to allow its performance as an outpatient procedure.
Pelvic lymph node dissection was performed through bilateral 3 cm. incisions overlying the obturator fossa in 11 patients.
Nodes sampled ranged from 5 to 26 per patient that differed insignificantly from those undergoing standard pelvic lymph node dissection. Four patients had lymph node metastases. Nine procedures were performed entirely on an outpatient basis. One complication (external vein injury) was repaired with a single suture after extending the incision to 6 cm.
Outpatient pelvic lymph node dissection through small incisions provides an attractive alternative to standard or laparoscopic lymph node dissection. With further experience it may become the procedure of choice for staging prostatic carcinoma in patients with a high risk of pelvic lymph node metastases.
盆腔淋巴结清扫分期是大多数前列腺癌患者评估的重要组成部分。虽然腹腔镜盆腔淋巴结清扫术为标准盆腔淋巴结清扫术提供了一种替代方法，但它存在显著的学习曲线、较高的严重并发症发生率、频繁住院和更高的费用。我们试图改进盆腔淋巴结清扫技术，使其能够作为门诊手术进行。
对11例患者通过双侧位于闭孔窝上方3cm的切口进行盆腔淋巴结清扫。
每位患者采集的淋巴结数量为5至26个，与接受标准盆腔淋巴结清扫的患者相比无显著差异。4例患者有淋巴结转移。9例手术完全在门诊进行。1例并发症（外静脉损伤）在将切口延长至6cm后用单根缝线修复。
通过小切口进行门诊盆腔淋巴结清扫为标准或腹腔镜淋巴结清扫提供了一种有吸引力的替代方法。随着经验的积累，它可能成为盆腔淋巴结转移高危患者前列腺癌分期的首选手术。
