Schneider A, Krause N, Kühne-Heid R, Kamprath S, Endisch U, Merker A, Nöschel H
Abteilung für Frauenheilkunde, Friedrich-Schiller-Universität Jena.
Zentralbl Gynakol. 1996;118(9):498-504.
It was the aim of this study to establish and analyze the laparoscopic technique of para-aortic and pelvic lymphadenectomy. During a one year period (from August 1994 till July 1995) 42 patients underwent pelvic and para-aortic laparoscopic lymphadenectomy. In 29 cases cervical cancer, in 11 cases endometrial cancer and in 2 cases tumors of low malignant potential of the ovary were the indication for lymphadenectomy which was combined with radical vaginal hysterectomy in 19 patients or simple vaginal hysterectomy in 13 patients. During the observation period the mean operating time for para-aortic and pelvic lymphadenectomy decreased and the efficiency of the lymphadenectomy increased significantly: the mean operating time for the first 10 para-aortic lymphadenectomies was 52 minutes and for the pelvic lymphadenectomies 141 minutes, respectively. For the last 10 procedures the para-aortic part took 35 minutes and the pelvic part 110 minutes. Whereas at the beginning of the study a mean of 25 lymph nodes were removed, a mean of 36 lymph nodes were sampled during the last 10 procedures. In 3 patients operative injuries to major vessels were encountered of which two were followed by laparotomy. In 3 other patients laparotomy due to postoperative hemorrhage was necessary. These 6 complications occurred during the first half of the study and were not encountered during the following operations by changing from monopolar to bipolar coagulation and by modifying the regimen for perioperative thrombosis prophylaxis. In the first half of the study in 9 women blood transfusions were necessary and in the second half only 4 patients had to be transfused. In the first 10 patients the mean intraoperative blood loss was 1300 cc, in the last 10 patients 300 cc. After a short learning curve laparoscopic para-aortic and pelvic lymphadenectomy is a safe and effective technique for staging cervical, endometrial, and early ovarian cancers. Though this technique is no standard procedure results of this pilot study warrant prospective studies comparing this technique with conventional procedures.
本研究的目的是建立并分析腹腔镜下主动脉旁及盆腔淋巴结切除术技术。在一年期间（从1994年8月至1995年7月），42例患者接受了盆腔及主动脉旁腹腔镜淋巴结切除术。其中29例为宫颈癌，11例为子宫内膜癌，2例为卵巢低恶性潜能肿瘤，这些是淋巴结切除术的指征，19例患者将淋巴结切除术与根治性阴道子宫切除术联合进行，13例患者进行单纯阴道子宫切除术。在观察期内，主动脉旁及盆腔淋巴结切除术的平均手术时间缩短，淋巴结切除效率显著提高：最初10例主动脉旁淋巴结切除术的平均手术时间为52分钟，盆腔淋巴结切除术为141分钟。最后10例手术中，主动脉旁部分耗时35分钟，盆腔部分耗时110分钟。研究开始时平均切除25个淋巴结，最后10例手术中平均取样36个淋巴结。3例患者术中出现大血管损伤，其中2例随后进行了开腹手术。另外3例患者因术后出血需要开腹。这6例并发症发生在研究的前半段，通过从单极凝血改为双极凝血以及修改围手术期血栓预防方案，在后续手术中未再出现。研究前半段有9名女性需要输血，后半段只有4例患者需要输血。前10例患者术中平均失血量为1300毫升，最后10例患者为300毫升。经过短暂的学习曲线后，腹腔镜主动脉旁及盆腔淋巴结切除术是一种用于宫颈癌、子宫内膜癌和早期卵巢癌分期的安全有效的技术。尽管该技术并非标准手术，但这项初步研究的结果值得进行前瞻性研究，将该技术与传统手术进行比较。
