摘要
目的:介绍经腹膜外入路单孔腹腔镜后腹膜淋巴结清扫术的手术方法和随访结果.方法:对5例非精原细胞瘤睾丸肿瘤患者行睾丸切除术(3例右侧,2例左侧),术前甲胎蛋白(AFP)明显升高.睾丸切除术后3周行单孔腹腔镜后腹膜淋巴结清扫术.采用与患侧下腹腹直肌旁纵行3 cm切口,置入'两环一套法'自制开口器建立单孔腹腔镜通道.手术步骤及清扫范围同开放保留神经的后腹膜淋巴结清扫术(RPLND).结果:手术时间为240(180～270)min.术中失血量为50(20～100)ml,无需输血.无中转开放手术或增加工作通道病例.无围手术期死亡及严重并发症发生.术后病理检查结果除首例患者右髂外静脉周围淋巴结阳性,余切除的淋巴结均为阴性.随访3～24个月,AFP降至正常,未发现肿瘤复发和远处转移,患者对切口美容效果表示满意.结论:单孔腹腔镜经腹膜外入路后腹膜淋巴结清扫术是安全、可行的.经腹直肌旁腹膜外入路是理想的手术入路,美容效果较好.
Objective:To introduce our initial experience of laparoendoscopic single site(LESS)retroperitoneal lymph node dissection(RPLND)for treatment of nonseminomatous testicular cancer.Methods:From September 2010 to May 2012,5male patients(age 19-27 years old),present with enlarged right testicle and elevated alpha-fetoprotein(AFP)level,underwent radical orchidectomy.The histopathological analysis revealed nonseminomatous germ cell tumor.Laparoendoscopic single site retroperitoneal lymph node dissection(LESS-RPLND)was performed 3weeks after orchiectomy.After the 3cm right pararectus incision was made in right lower quadrant,the homemade port was inserted.Prebent devices,conventional straight laparoscopic equipments,30 degree lens,harmonic scalpel,bipolar forceps and Hem-o-lok clips were employed.Retroperitoneal space was created and developed with blunt dissection.The unilateral RPLND with nerve-sparing technique was conducted and modified right-sided template was removed in accordance with open RPLND.Results:The operation was successfully performed through the solo pararectus incision and mean operative time was 240 min.Mean estimated blood loss was 50 ml.No conversion to open or conventional laparoscopic surgery was required.No major perioperative complications was observed.For the first case,number of lymph nodes obtained on final histopathological examination was 11 and two positive nodes were detected.For the other 4cases,no positive nodes were detected.Chemotherapy was needed for the first case.AFP level decreased close to base line one week postoperatively and no relapse was observed 3 month after RPLND.Conclusions:In our experience,LESS-RPLND is safe and feasible,and pararectus incision gains good approach and satisfied cosmetic result.Large population-bases study and long time follow-up were needed to prove the oncological outcome of LESS-RPLND.
出处
《微创泌尿外科杂志》
2012年第1期84-87,共4页
Journal of Minimally Invasive Urology
关键词
单孔腹腔镜
后腹膜淋巴结清扫术
非精原细胞瘤
睾丸肿瘤
laparoendoscopic single-site surgery
retroperitoneal lymph node dissection
nonseminomatous germ cell tumors
testicular cancer
