Su T H, Wang K G, Yang Y C, Hong B K, Huang S H
Department of Obstetrics and Gynecology, Mackay Memorial Hospital and Taipei Medical College, Taiwan.
Int J Gynaecol Obstet. 1995 Jun;49(3):311-8. doi: 10.1016/0020-7292(95)02367-l.
To assess the efficacy and risks of laparoscopic para-aortic lymph node sampling compared with standard laparotomy in staging cervical carcinoma.
From August 1993 through July 1994, 38 patients with biopsy-proven invasive cervical carcinoma (24 early and 14 advanced invasive cancers) were entered into the study. This was a prospective study of laparoscopic para-aortic lymphadenectomy in invasive cervical carcinoma, with patients serving as their own controls. Video laparoscopic lymph node sampling was performed. In patients with early invasive cancer, the nodes were sent for frozen section and, if negative, laparotomy was performed to look for any residual nodes. Radical hysterectomy was performed immediately if residual nodes were negative. Patients with either nodal metastasis on frozen section or with advanced cancer underwent para-aortic lymphadenectomy only. The operative technique was also evaluated.
Laparoscopy required an average of 77 min (S.D. 40), with an average blood loss of 116 ml (S.D. 321). The average number of nodes was 15 (S.D. 7). At subsequent laparotomy the average number of residual nodes found was 0.4 (S.D. 0.9) and none showed metastasis. One vena cava laceration and one ureteral injury required immediate repair, and two patients were too obese to undergo laparoscopy.
Laparoscopic para-aortic lymph node sampling is a less invasive, reliable method for staging invasive cervical carcinoma and can substitute for traditional open procedures. The incidence of risks with this method appears to be low.
评估与标准剖腹术相比，腹腔镜腹主动脉旁淋巴结取样在宫颈癌分期中的疗效和风险。
从1993年8月至1994年7月，38例经活检证实为浸润性宫颈癌的患者（24例早期浸润癌和14例晚期浸润癌）纳入本研究。这是一项关于浸润性宫颈癌腹腔镜腹主动脉旁淋巴结清扫术的前瞻性研究，患者自身作为对照。进行了视频腹腔镜淋巴结取样。对于早期浸润癌患者，将淋巴结送去做冰冻切片检查，如果结果为阴性，则进行剖腹术以寻找任何残留淋巴结。如果残留淋巴结为阴性，则立即进行根治性子宫切除术。冰冻切片检查发现有淋巴结转移或患有晚期癌症的患者仅进行腹主动脉旁淋巴结清扫术。还对手术技术进行了评估。
腹腔镜检查平均需要77分钟（标准差40），平均失血量为116毫升（标准差321）。平均淋巴结数量为15个（标准差7）。在随后的剖腹术中，发现的残留淋巴结平均数量为0.4个（标准差0.9），且均未显示转移。1例腔静脉撕裂和1例输尿管损伤需要立即修复，2例患者过于肥胖无法进行腹腔镜检查。
腹腔镜腹主动脉旁淋巴结取样是一种侵入性较小、可靠的浸润性宫颈癌分期方法，可替代传统的开放手术。该方法的风险发生率似乎较低。
