腹腔镜下腹膜后淋巴结清扫术治疗临床Ⅰ期睾丸非精原细胞肿瘤7例报告

Laparoscopic retroperitoneal lymph node dissection for clinical stage Ⅰ nonseminomatous germ cell tumor (Report of 7 cases)

目的:探讨腹腔镜下腹膜后淋巴结清扫术治疗临床Ⅰ期睾丸非精原细胞肿瘤的临床经验及疗效。方法:回顾性分析2008年10月～2011年6月7例睾丸非精原细胞癌的临床资料,其中左侧4例,右侧3例,平均年龄(34±11)岁,胚胎癌5例,混合性生殖细胞肿瘤2例。术前临床分期均为I期;7例患者均在根治性睾丸切除术后1周行腹腔镜下腹膜后淋巴结清扫术。结果:所有手术均顺利完成,无中转开放,围手术期无严重并发症。平均手术时(172±35)min,术中平均出血量(43±14)ml,平均切除淋巴结(12±3)个,淋巴结阳性患者2例。术后平均住院时间(6±2)d,术后平均随访(25±10)个月,所有患者术后射精功能正常,肿瘤无局部复发及远处转移。结论:腹腔镜下腹膜后淋巴结清扫术安全、有效,具有创伤小、恢复快等优点,可作为明确诊断和治疗临床Ⅰ期睾丸非精原细胞肿瘤的首选方法。

Objective：To study the clinical experiences and effects of laparoscopic retroperitoneal lymph node dissection for clinical stage I nonseminomatous germ cell tumor. Method： From October 2008 to June 2011,7 cases of nonseminomatous germ cell tumor（embryonal tumor in 5 cases and mixed germ cell tumor in 2 cases）were retro- spectively analyzed. Mean age was（34±11）years,with 4 case on the left side and 3 cases on the right side. All of the 7 patients received laparoscopic retroperitoneal lymph node dissection one week after＇radical orchiectomy. Result： 7 cases were operated successfully without conversion to open surgery,no severe perioperative complications. The mean operation time was（172±35）min,and mean blood loss was（43±14）ml;the mean dissected lymph node number was（12±3）, and active tumor was found in retroperitoneal lymph node dissection specimens in 2 cases. Mean postoperative hospital stay was（6±2） days, in a mean follow up for（25 ±10）months,all patients with normal antegrade ejaculation,no local tumor recurrence and distant metastasis during follow-up. Conclusion： laparoscopic retroperitoneal lymph node dissection is safe and effective with less trauma and faster recovery of its advantages, and it can be used as first-line choice for the diagnosis and treatment of clinical stage I nonseminomatous germ cell tumor.