腹腔镜腹膜后淋巴结清扫术11例报告

Laparoscopic retroperitoneal lymph node dissection:Report of 11 cases

目的探讨采用腹腔镜技术行腹膜后淋巴结清扫术在睾丸肿瘤治疗中的技术可行性。方法 2006年4月至2009年9月11例原发性睾丸非精原细胞性生殖细胞肿瘤根治性睾丸切除术后1周行腹腔镜腹膜后淋巴结清扫术,其中,胚胎癌8例,混合癌3例;术前临床分期:Ⅰ期9例,Ⅱb期2例;右侧10例,左侧1例。结果 11例手术均取得成功,手术平均时间280min;术中出血量1例30～600ml,平均100ml,无输血,无邻近重要脏器损伤,平均切除淋巴结12个。术后淋巴漏1例,饮食控制后1周治愈。术后平均住院时间9d。术后随访6～48个月,无肠粘连、肠梗阻及淋巴囊肿等发生,无肿瘤复发及远处转移。结论腹腔镜腹膜后淋巴结清扫术技术可行,创伤小、并发症少、术后恢复快。

Objective To investigate surgical technique feasibility of laparoscopic retroperitoneal lymph node dissection （LRPLND） in the treatment of testicular tumor. Methods From April 2006 to September 2009, 11 patients with primary testicular n tous germ cell tumors （NSGCT） received LRPLND at 1 week after orchiectomy. 9 cases were on clinical stage I and 2 cases were on clinical stage lI b. 10 patients were right side, only one patient was left side. Results All the operations were successfully performed. The mean operating time was 280 min, the mean intraoperative blood loss war 100 ml （30-600） None of the patients required blood transfusion and no case had major injuries or complications. The mean dissectied lymph node number was 12. Mild chylous occuredin 1 patient, which was cured within 1 week by low-fat diet. The mean hospital stay was 9 days. No evidence of recurrence or distant metastasis was found during the follow-up of 6--48 months after the operation. Conclusions LRPLND is technically feasible, the morbidity and complication were significantly lower. Once the learning curve has been overcome, the operative time could decreased significantly.