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作者介绍一种改良的盆腔淋巴清扫术——撕拉式盆腔淋巴清扫术。手术操作方法:按一般盆腔手术,切开腹壁进入腹腔后,在两侧阔韧带打开腹膜后,暴露髂血管,血髂外动脉外侧2cm向内清扫脂肪及淋巴。上自髂内外动脉交叉以上2～3cm处开始先切断髂总淋巴管。近心端结扎,将远心端以弯血管钳夹住沿髂外血管平行的方向,自上向下钝性撕拉。将整片的髂总、髂外淋巴撕下直到腹股沟深淋巴,将腹股沟深淋巴捏于术者的食指及拇指间撕拉而下,此后沿髂外静脉的内侧壁打开血管鞘膜,以食指钝性分离,暴露闭孔窝,再在闭孔神经的内侧钝性暴露膀胱侧窝及闭孔神经。将闭孔神经夹于食指及中指间,自下而上将闭孔淋巴及髂内淋巴钝性撕下,然后向内侧连同宫旁淋巴一并撕下,这就完成了一侧的淋巴清扫。另一侧同样施行。
The authors describe a modified pelvic lymphadenectomy - tearing pelvic lymphadenectomy. Surgical procedures: According to the general pelvic surgery, incision abdominal wall into the abdominal cavity, both sides of the broad ligament after opening the peritoneum, exposed iliac vessels, blood outside the external iliac artery 2cm inwards to clean the fat and lymph. Since the internal and external iliac artery cross above 2 ~ 3cm began to cut off the first common iliac lymphatic. Near the end of the heart ligation, the distal end of the vascularized forceps clamp along the external iliac vessels parallel to the direction of blunt tearing from top to bottom. The entire iliac, external iliac lymph nodes removed until deep inguinal lymph, the inguinal deep lymphatic pinch in the surgeon and thumb between the tear and down, then along the medial wall of the external iliac vein to open the blood vessel sheath to the index finger Blunt dissection, exposure of closed-cell fossa, obtuse the inside of the obturator nerve exposed bladder fossa and obturator nerve. The obturator nerve is sandwiched between the index finger and middle finger, bottom-up will obturator and iliac lymphatic tear, and then to the medial paralyzed with paralyzed lymph, which completed the side of the lymph node dissection. The same applies to the other side.