腹膜外盆腔淋巴结清扫术在妇科恶性肿瘤根治术中的应用

Application of extraperitoneal pelvic lymphadenectomy in radical surgery operation of gynecological malignancy

目的探讨在妇科恶性肿瘤根治性手术中采用腹膜外盆腔淋巴结清扫术的优势。方法在浸润性宫颈癌及子宫内膜癌的根治性手术中，选择47例行腹膜外盆腔淋巴结清扫术，并对该术式的操作方法及其优势作了详细的阐述。结果除术中右髂总静脉及左闭孔静脉损伤各1例外，其余患者手术操作顺利。术中无恶心呕吐等胃肠道反应及心血管并发症，与腹膜内清扫术相比节省时间30min；术后并发淋巴囊肿11例，腹壁切口淋巴漏1例，均经相应治疗后痊愈。结论在宫颈癌及子宫内膜癌的根治性手术中采用腹膜外盆腔淋巴结清扫术，具有术野显露良好，无需腹壁自动牵开器，对盆腹腔干扰时间晚而短，避免因探查等操作而引起的恶心呕吐、血压下降等不良反应及减少术后肠粘连肠梗阻并发症等优点，而且坚持了“包抄歼癌”的手术原则，缩短了手术操作时间。

Objective To investigate advantages of extraperitoneal pelvic lymphadenectomy adopted in radical surgery operation of gynecological malignancy. Methods In radical surgery operations of invasive cervical carcinoma and endometrial carcinoma,47 cases were choosed to be done with extraperitoneal pelvic lymphadenectomy, the method of the operation and its advantages are also elaborated in detail. Results In addition to the results of the right common iliac vein and left obturator vein injury each exception, and the remaining patients were operated smoothly, with none of gastrointestinal reactions such as nausea and vomiting, and other cardiovascular complications. The operational time shortened 30 minutes compared with innerperitoneal lymphadenectomy. 11 cases with lymphatic cyst and 1 case with abdominal incision lymphatic leak occurred after operation have been recovered after corresponding treatment. Conclusion The adoption of extraperitoneal pelvic lymphadenectomy in radical surgery operation of cervical cancer and endometrial cancer has the advantages of a good exposure of operational field, no need of the abdominal wall automatic retractor, a late and short abdominal inter- fere, the avoidance of adverse effects such as nausea, vomiting, blood pressure decreasing caused by operational exploratory and reduction of complications such as intestinal obstruction and intestine adhesion during and after operation, and adhere to the ＂F-outflanking cancer,＂ the operative principle, shorten the operation time.