PDF(Pubmed)
Abstract：
UNASSIGNED: With the widespread use of positron emission tomography and computed tomography (PET/CT), a significantly greater proportion of patients with advanced ovarian cancer (OC) are now diagnosed with superior renal-vein lymph node metastases involving retrocrural and mediastinal nodes. To the authors\' knowledge, retrocrural lymphadenectomy has not yet been reported in patients with OC. The authors performed retrocrural lymph node resection in a patient with ovarian cancer.
UNASSIGNED: A 64-year-old woman with ovarian cancer who had not undergone surgery upon initial diagnosis was admitted to the authors\' hospital because tumour markers increased during bevacizumab maintenance therapy. PET/CT imaging revealed adnexal masses and multiple metastases in pelvic, para-aortic, retrocrural, and mediastinal lymph nodes. Reduction surgery was performed, and retrocrural lymph nodes were excised. However, the patient\'s postoperative course was complicated by a chylothorax. Because of the failure of conservative treatment, interventional embolization was performed, but failed to obstruct lymphatic vessels. The patient underwent reoperation. A fistula was located where Hem-o-lock clips penetrated the pleura, clearly indicating the injury site, which was then sutured and embedded in the surrounding diaphragmatic tissue and filled with gel sponge. The patient recovered from chylous leakage postoperatively. She later underwent chemotherapy and targeted maintenance therapy.
UNASSIGNED: The authors may have injured the communicating branch of the thoracic duct posterior to the diaphragm during the first operation and did not ligate it. The accumulated chylous fluid finally penetrated through the weak point on the pleura and led to chylothorax 3 days later. If conservative treatment or interventional embolization are unsuccessful, surgical treatment should be selected in time.
UNASSIGNED: The location of the retrocrural lymph node at the anastomosis of the chylous cistern and the thoracic duct may pose a significant risk of chylous leakage as a complication of lymphadenectomy. Full exposure of the surgical field and thorough ligation of the lymphatic vessels may lead to successful superior renal-vein lymphadenectomy.
UNASSIGNED: A 64-year-old woman with ovarian cancer who had not undergone surgery upon initial diagnosis was admitted to the authors\' hospital because tumour markers increased during bevacizumab maintenance therapy. PET/CT imaging revealed adnexal masses and multiple metastases in pelvic, para-aortic, retrocrural, and mediastinal lymph nodes. Reduction surgery was performed, and retrocrural lymph nodes were excised. However, the patient\'s postoperative course was complicated by a chylothorax. Because of the failure of conservative treatment, interventional embolization was performed, but failed to obstruct lymphatic vessels. The patient underwent reoperation. A fistula was located where Hem-o-lock clips penetrated the pleura, clearly indicating the injury site, which was then sutured and embedded in the surrounding diaphragmatic tissue and filled with gel sponge. The patient recovered from chylous leakage postoperatively. She later underwent chemotherapy and targeted maintenance therapy.
UNASSIGNED: The authors may have injured the communicating branch of the thoracic duct posterior to the diaphragm during the first operation and did not ligate it. The accumulated chylous fluid finally penetrated through the weak point on the pleura and led to chylothorax 3 days later. If conservative treatment or interventional embolization are unsuccessful, surgical treatment should be selected in time.
UNASSIGNED: The location of the retrocrural lymph node at the anastomosis of the chylous cistern and the thoracic duct may pose a significant risk of chylous leakage as a complication of lymphadenectomy. Full exposure of the surgical field and thorough ligation of the lymphatic vessels may lead to successful superior renal-vein lymphadenectomy.
摘要：
■随着正电子发射断层扫描和计算机断层扫描（PET/CT）的广泛使用，现在,更多的晚期卵巢癌(OC)患者被诊断患有累及小腿后和纵隔淋巴结的上肾静脉淋巴结转移.就作者所知，在OC患者中，尚未有硬膜外后淋巴结清扫术的报道。作者对一名卵巢癌患者进行了脊后淋巴结切除术。
一名64岁的卵巢癌患者在最初诊断时没有接受手术，因为在贝伐单抗维持治疗期间肿瘤标志物增加，因此被纳入作者医院。PET/CT显像提示盆腔附件肿块及多发转移灶，主动脉旁,后背,纵隔淋巴结.进行了复位手术，并切除后肢淋巴结。然而,患者的术后过程并发乳糜胸。由于保守治疗的失败，进行了介入栓塞,但未能阻塞淋巴管.患者接受了再次手术。瘘管位于Hem-o-lock夹子穿透胸膜的位置，清楚地表明受伤部位，然后将其缝合并嵌入周围的膈肌组织中，并用凝胶海绵填充。患者术后乳糜渗漏恢复。她后来接受了化疗和靶向维持治疗。
■作者可能在第一次手术中受伤了隔膜后方的胸导管的连通分支，并且没有结扎。积累的乳糜液最终穿透胸膜上的弱点，并在3天后导致乳糜胸。如果保守治疗或介入栓塞不成功，应及时选择手术治疗。
■乳糜池和胸导管吻合处后颈淋巴结的位置可能会引起乳糜漏，这是淋巴结清扫术的并发症。充分暴露手术区域和彻底结扎淋巴管可能会导致成功的上肾静脉淋巴结清扫术。
一名64岁的卵巢癌患者在最初诊断时没有接受手术，因为在贝伐单抗维持治疗期间肿瘤标志物增加，因此被纳入作者医院。PET/CT显像提示盆腔附件肿块及多发转移灶，主动脉旁,后背,纵隔淋巴结.进行了复位手术，并切除后肢淋巴结。然而,患者的术后过程并发乳糜胸。由于保守治疗的失败，进行了介入栓塞,但未能阻塞淋巴管.患者接受了再次手术。瘘管位于Hem-o-lock夹子穿透胸膜的位置，清楚地表明受伤部位，然后将其缝合并嵌入周围的膈肌组织中，并用凝胶海绵填充。患者术后乳糜渗漏恢复。她后来接受了化疗和靶向维持治疗。
■作者可能在第一次手术中受伤了隔膜后方的胸导管的连通分支，并且没有结扎。积累的乳糜液最终穿透胸膜上的弱点，并在3天后导致乳糜胸。如果保守治疗或介入栓塞不成功，应及时选择手术治疗。
■乳糜池和胸导管吻合处后颈淋巴结的位置可能会引起乳糜漏，这是淋巴结清扫术的并发症。充分暴露手术区域和彻底结扎淋巴管可能会导致成功的上肾静脉淋巴结清扫术。
