血管悬吊法腹腔镜腹主动脉及下腔静脉后淋巴结切除

Vascular Suspension in Laparoscopic Lymphadenectomy of Retroaortic and Retrocaval Lymph Nodes

目的探讨血管悬吊法腹腔镜腹主动脉及下腔静脉后淋巴结切除的可行性和安全性。方法2018年6月~2020年12月,对术前影像学提示或术中发现腹主动脉及下腔静脉周围淋巴结肿大的7例子宫内膜癌和8例卵巢癌行全面分期手术,悬吊腹主动脉及下腔静脉,完成腹腔镜腹主动脉及下腔静脉后淋巴结切除。结果手术顺利。子宫内膜癌和卵巢癌中位淋巴结切除数分别为45(36~78)、50(35~63)枚,其中盆腔淋巴结25(20~49)、28(16~31)枚,腹主动脉旁淋巴结20(12~32)、23(15~37)枚。2例卵巢癌下腔静脉后淋巴结阳性。术中、术后均未出现大出血。1例卵巢癌术后乳糜漏。结论使用血管悬吊法行腹腔镜腹主动脉及下腔静脉后淋巴结切除是安全、可行的。

Objective To investigate the feasibility and safety of vascular suspension in laparoscopic lymphadenectomy of retroaortic and retrocaval lymph nodes.Methods Between June 2018 and December 2020,comprehensive staging surgeries were performed in 7 cases of endometrial cancer and 8 cases of ovarian cancer with enlarged lymph nodes around abdominal aorta and inferior vena cava by preoperative imaging evaluation or intraoperative discovery.The abdominal aorta and inferior vena cava were suspended and laparoscopic lymphadenectomy of retroaortic and retrocaval lymph nodes were completed.Results The operation was smoothly accomplished.For endometrial cancer and ovarian cancer,the median number of lymph nodes removed were 45(36-78)and 50(35-63),respectively,including 25(20-49)and 28(16-31)pelvic lymph nodes and 20(12-32)and 23(15-37)para-aortic lymph nodes.Two patients of ovarian cancer showed positive retrocaval lymph nodes.No massive haemorrhage occurred during and after the operation.Chyle leakage after surgery occurred in 1 case of ovarian cancer.Conclusion It is safe and feasible to perform laparoscopic lymphadenectomy with vascular suspension for retroaortic and retrocaval lymph nodes.