妇科恶性肿瘤腹膜后淋巴结切除术路径、要点及并发症防治

Route and main points of retroperitoneal lymph node dissection for gynecological malignancies and the prevention and treatment of complications

腹膜后(包括盆腔和腹主动脉旁)淋巴结切除在妇科恶性肿瘤的治疗中有重要的作用,常见的手术路径包括经腹腔路径和腹膜外路径。手术路径的选择取决于疾病治疗的整体方式、患者的特点和手术医师的技术特点。手术需要由有经验的妇科肿瘤医师实施。术中及术后近期并发症包括血管损伤、输尿管损伤、肠管损伤、神经损伤、围手术期感染,远期并发症最常见的是术后淋巴囊肿和下肢淋巴水肿。在淋巴囊肿和下肢淋巴水肿的预防中,应注意术后开放后腹膜,尽量避免使用引流管及合理使用能量器械等。

Retroperitoneal lymph node dissection,including pelvic and para-aortic lymphadenectomy,is of great importance in gynecological malignancies treatment.Lymphadenectomy can be performed via transperitoneal or extraperitoneal route.The surgical approach used for a lymphadenectomy procedure in gynecological oncology is typically determined by the best approach for the total procedure,patient characteristics and surgeon＇s experience.Surgery needs to be operated by an experienced gynecologic oncologist.The most frequent intraoperative and postoperative complication is vascular injury,followed by ureteral injury,bowel injury,neurologic injury,or perioperative infection.Late-postoperative complications consist mainly of symptomatic lymphatic lymphocyte（SPOL） and lower extremity lymphedema（LEL）.Several techniques may decrease the incidence of SPOL and LEL.Thus,energy equipment should be rationally used during the procedure,the peritoneum should be left open and tube drains should be avoided.