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目的初步探讨后腹腔镜腹膜后淋巴结清扫术的手术方法及临床疗效。方法 4例临床Ⅰb期睾丸非精原细胞瘤患者,行根治性睾丸切除术后,经4通道按Innsbruck大学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、围术期并发症、术后恢复情况及所清除淋巴结病理结果,随访瘤控情况及性功能。结果 4例手术均成功完成,手术早期腹膜破裂1例,暴露不佳,手术较困难。手术时间分别为150、310、290、250min,术中出血分别为120、250、200、50mL。术中下腔静脉和腰静脉、腹主动脉损伤各1例,均镜下成功止血。术后24~48h恢复通气,术后4~7d拔出引流,无明显术后并发症。病理提示:淋巴结阳性分别为0/10,1/17,0/13,0/9枚,淋巴结阳性1例予术后辅助化疗2个疗程。随访6月4例均可顺行射精,腹膜后和肺CT及瘤标检查正常。结论初步观察,后腹腔镜腹膜后淋巴结清扫术,瘤控效果好,勃起和射精满意,术后并发症少。但对术者技术要求较高。
Objective To investigate the surgical methods and clinical effects of retroperitoneal laparoscopic retroperitoneal lymph node dissection. Methods Four patients with stage Ⅰb testicular nonseminomas were treated with radical orchiectomy and retroperitoneal laparoscopic retroperitoneal lymphadenectomy according to the 4-channel modified template of Innsbruck University. Observed operation time, intraoperative blood loss, perioperative complications, postoperative recovery and pathological results of lymph node dissection were followed up for tumor control and sexual function. Results All 4 cases were successfully performed. One case of early peritoneal rupture of the operation had poor exposure and the operation was difficult. The operation time was 150, 310, 290, 250min respectively. The intraoperative bleeding was 120, 250, 200 and 50mL respectively. Intraoperative inferior vena cava and lumbar vein, abdominal aorta injury in 1 case, both under the microscope to stop bleeding. Ventilation was resumed from 24 to 48 hours after operation, and drainage was withdrawn from 4 to 7 days after operation. There was no obvious postoperative complications. Pathological findings: lymph node positive were 0/10, 1 / 17,0 / 13,0 / 9, lymph node positive in 1 case postoperative adjuvant chemotherapy for 2 courses. Follow-up in 4 cases in June were ejaculation, retroperitoneal and lung CT and tumor markers were normal. Conclusions Preliminary observation, retroperitoneal laparoscopic retroperitoneal lymph node dissection, tumor control effect, erection and ejaculation satisfaction, less postoperative complications. But the technical requirements of the surgeon higher.