Possover M, Krause N, Plaul K, Kühne-Heid R, Schneider A
Department of Gynecology, Friedrich-Schiller-University, Jena, Germany.
Gynecol Oncol. 1998 Oct;71(1):19-28. doi: 10.1006/gyno.1998.5107.
The clinical usefulness of laparoscopic pelvic and para-aortic lymphadenectomy for staging and therapy of gynecological cancer was analyzed prospectively.
Laparoscopic para-aortic and pelvic lymphadenectomy was performed in 150 patients with cervical (n = 96), endometrial (n = 41), or ovarian cancer (n = 13). Lymphadenectomy was combined with laparoscopically assisted vaginal radical hysterectomy in 70 patients, with laparoscopically assisted vaginal hysterectomy and/or bilateral salpingo-oophorectomy and/or appendectomy and/or omentectomy in 24 patients, with trachelectomy in 2 patients, and with laparoscopic radical hysterectomy in 2 patients; lymphadenectomy alone was performed in 52 patients. Right-sided para-aortic lymphadenectomy extended to the level of the right ovarian vein; left-sided dissection reached the level of the inferior mesenteric artery. In ovarian tumors, dissection was extended to the level of the renal vessels; in addition, the ovarian vessels were removed with the surrounding tissue. Peri- and postoperative data were collected prospectively to monitor progress of surgical performance.
Mean operative time was 36 min (15-105 min) for right-sided para-aortic and 24 min (12-49 min) for left-sided para-aortic lymphadenectomy; bilateral pelvic lymphadenectomy took 64 min (44-110 min). On average 26.8 (10-56) pelvic lymph nodes and 7.3 (0-19) para-aortic lymph nodes were sampled. Major vessels were injured in 7 patients of which 4 patients required laparotomy. Patients undergoing lymphadenectomy alone were admitted for 3.2 days on average.
Laparoscopic para-aortic and pelvic lymphadenectomy is effective for staging and treatment of gynecologic cancers.
前瞻性分析腹腔镜盆腔及腹主动脉旁淋巴结切除术在妇科癌症分期及治疗中的临床实用性。
对150例宫颈癌（n = 96）、子宫内膜癌（n = 41）或卵巢癌（n = 13）患者实施腹腔镜腹主动脉旁及盆腔淋巴结切除术。70例患者的淋巴结切除术与腹腔镜辅助阴式根治性子宫切除术联合进行，24例患者与腹腔镜辅助阴式子宫切除术和/或双侧输卵管卵巢切除术和/或阑尾切除术和/或大网膜切除术联合进行，2例患者与宫颈切除术联合进行，2例患者与腹腔镜根治性子宫切除术联合进行；52例患者单独进行淋巴结切除术。右侧腹主动脉旁淋巴结切除术延伸至右卵巢静脉水平；左侧解剖达到肠系膜下动脉水平。对于卵巢肿瘤，解剖延伸至肾血管水平；此外，将卵巢血管与周围组织一并切除。前瞻性收集围手术期和术后数据以监测手术操作进展。
右侧腹主动脉旁淋巴结切除术的平均手术时间为36分钟（15 - 105分钟），左侧腹主动脉旁淋巴结切除术为24分钟（12 - 49分钟）；双侧盆腔淋巴结切除术耗时64分钟（44 - 110分钟）。平均取样26.8个（10 - 56个）盆腔淋巴结和7.3个（0 - 19个）腹主动脉旁淋巴结。7例患者主要血管受损，其中4例患者需要开腹手术。单独接受淋巴结切除术的患者平均住院3.2天。
腹腔镜腹主动脉旁及盆腔淋巴结切除术对妇科癌症的分期及治疗有效。
