后腹腔镜腹膜后淋巴结清扫术17例报道  

Laparoscopic retroperitoneal lymph node dissection:Report of 17 cases

作　　者：肖龙[1] 肖民辉[1] 余闫宏[1] 徐万超[1] Xiao Long;Xiao Minhui;Yu Yanhong;Xu Wanchao(Department of Urology,the first People's Hospital of Yunnan Province,Kunming 650041,China;Kunming University of Science and Technology,Kunming 650041,China)

机构地区：[1]云南省第一人民医院泌尿外科昆明理工大学,昆明650041

出　　处：《中华腔镜泌尿外科杂志（电子版）》2019年第2期76-79,共4页Chinese Journal of Endourology(Electronic Edition)

摘　　要：目的初步探讨后腹腔镜腹膜后淋巴结清扫术对Ⅰ期睾丸非精原细胞瘤患者的控瘤效果、并发症及安全性。方法回顾性分析我科2009年4月到2015年5月收治17例临床Ⅰ期睾丸非精原细胞瘤患者的临床资料,行根治性睾丸切除术后,经4通道按Innsbruck大学的改良模板行后腹腔镜腹膜后淋巴结清扫术。观察手术时间、术中出血量、术中术后并发症、术后恢复情况及所清除淋巴结病理结果,随访控瘤及保留性功能效果。结果 17例手术均成功完成,手术早期腹膜损伤后暴露不佳1例。手术时间平均为220 min(150～310 min),术中出血平均为150 ml(50～260 ml)。术中腰静脉损伤出血2例,均在镜下成功止血。术后24～48 h恢复肠道通气,术后4～7 d拔除引流管,无严重术后并发症。病理提示:淋巴结阳性率为11.8%(2/17),淋巴结阳性患者予术后辅助化疗2个疗程。随访6个月14例可顺行射精,复查肺部和腹膜后CT及肿瘤标志物检查未显示异常。结论后腹腔镜腹膜后淋巴结清扫术安全,控瘤效果好,术后并发症少、恢复快,但对术者技术要求较高。Objective To assess the efficacy,complications and safety of laparoscopic retroperitoneal lymph node dissection(LRPLND)for stageⅠtesticular germ cell tumor(GCT)patients.Methods Seventeen patients with stageⅠnon-seminoma germ cell testicular tumor underwent LRPLND after orchectomy at our institution between April 2009 and May 2015,and the morbidity and oncologic outcome were reviewed retrospectively.The procedure was performed according to the improving template of Innsbruck University on L-RPLND.Result All procedures were successfully accomplished.At the early stage,1 case of procedure was slightly difficult for the peritoneal injury and present as the poor exposure.The average operative time was 220 min(150-310 min),the average intraoperative blood loss was 150 ml(50-260 ml).During the procedure,the lumbar vein injury and hemorrhage occurred in 2 cases,hemostasis was performed successfully under the laparoscope.The recovery of bowel function was 24~48 h.Drainage tube was removed after 4-7 days.No severe postoperative complications were observed.Pathological information indicated that the lymph node positive rate is 11.8%(2/17)and 2 cases with lymph node positive had been given the adjuvant chemotherapy.Fourteen cases were followed up for 6 months and had the normal antograde ejaculation,and the tumor marker,the lungs and retroperitoneal CT were normal.Conclusion LRPLND had shown that the surgical safety well and good oncologic outcome,and the patients with less complications and faster recovery,but to require the urologist with good skills.

关 键 词：后腹腔镜 淋巴结清扫术 非精原细胞肿瘤 腹腔后间隙 

分 类 号：R737.21[医药卫生—肿瘤]