Abstract：
OBJECTIVE: Para-aortic lymph node dissection (PALND) is a widely used treatment that causes many complications. This study is to evaluate the efficacy and safety of nerve-sparing para-aortic lymph node dissection (NSPALND) by comparing it with conventional PALND in gynecological malignancies and to prove whether locating the superior hypogastric plexus (SHP) can help reveal the para-aortic nerves.
METHODS: This is a retrospective study of the patients who underwent para-aortic lymphadenectomy from January 2020 to December 2022 at Zhejiang Cancer Hospital. All of them were divided into NSPALND and PALND groups according to whether or not nerve-sparing was performed. The surgical, functional and oncological outcomes were evaluated.
RESULTS: There were 43 patients enrolled, of which, 20 patients underwent NSPALND and 23 patients underwent PALND. The para-aortic nerves were successfully revealed by locating the SHP in all 20 cases of NSPALND. The post-operative anal exhaust time in the NSPALND group was significantly shorter than that in the PALND group (2.5 vs. 4 days, p=0.006), and the incidence of acute intestinal obstruction in the NSPALND group was significantly lower than that in the PALND group (10% vs. 39%, p=0.029). There was no difference between the two groups in terms of catheterization duration, urinary retention, dysuria, as well as the number of lymph nodes removed and the para-aortic recurrence rate.
CONCLUSIONS: NSPALND can significantly reduce the rate of acute intestinal obstruction and improve post-operative intestinal function. Locating the SHP and using it as an anatomical landmark to reveal the para-aortic nerves is feasible. Its exact clinical value needs to be further studied.
METHODS: This is a retrospective study of the patients who underwent para-aortic lymphadenectomy from January 2020 to December 2022 at Zhejiang Cancer Hospital. All of them were divided into NSPALND and PALND groups according to whether or not nerve-sparing was performed. The surgical, functional and oncological outcomes were evaluated.
RESULTS: There were 43 patients enrolled, of which, 20 patients underwent NSPALND and 23 patients underwent PALND. The para-aortic nerves were successfully revealed by locating the SHP in all 20 cases of NSPALND. The post-operative anal exhaust time in the NSPALND group was significantly shorter than that in the PALND group (2.5 vs. 4 days, p=0.006), and the incidence of acute intestinal obstruction in the NSPALND group was significantly lower than that in the PALND group (10% vs. 39%, p=0.029). There was no difference between the two groups in terms of catheterization duration, urinary retention, dysuria, as well as the number of lymph nodes removed and the para-aortic recurrence rate.
CONCLUSIONS: NSPALND can significantly reduce the rate of acute intestinal obstruction and improve post-operative intestinal function. Locating the SHP and using it as an anatomical landmark to reveal the para-aortic nerves is feasible. Its exact clinical value needs to be further studied.
摘要：
目的：主动脉旁淋巴结清扫术（PALND）是一种广泛使用的治疗方法，会引起许多并发症。本研究旨在通过与妇科恶性肿瘤的常规PALND比较，评估保留神经的主动脉旁淋巴结清扫术（NSPALND）的有效性和安全性，并证明定位上腹下丛（SHP）是否有助于揭示主动脉旁神经。
方法：本研究是对浙江省肿瘤医院2020年1月至2022年12月行主动脉旁淋巴结清扫术患者的回顾性研究。根据是否保留神经分为NSPALND组和PALND组。手术，评估了功能和肿瘤结局.
结果：共纳入43例患者，其中，20例患者接受NSPALND，23例患者接受PALND。通过在所有20例NSPALND中定位SHP成功揭示了主动脉旁神经。NSPALND组术后肛门排气时间明显短于PALND组(2.5vs.4天,p=0.006),NSPALND组急性肠梗阻发生率明显低于PALND组(10%vs.39%,p=0.029)。两组导尿时间无差异,尿潴留,排尿困难,以及切除的淋巴结数量和主动脉旁复发率。
结论：NSPALND能显著降低急性肠梗阻的发生率，改善术后肠功能。定位SHP并将其用作解剖标志以揭示主动脉旁神经是可行的。其确切临床价值有待进一步研讨。
方法：本研究是对浙江省肿瘤医院2020年1月至2022年12月行主动脉旁淋巴结清扫术患者的回顾性研究。根据是否保留神经分为NSPALND组和PALND组。手术，评估了功能和肿瘤结局.
结果：共纳入43例患者，其中，20例患者接受NSPALND，23例患者接受PALND。通过在所有20例NSPALND中定位SHP成功揭示了主动脉旁神经。NSPALND组术后肛门排气时间明显短于PALND组(2.5vs.4天,p=0.006),NSPALND组急性肠梗阻发生率明显低于PALND组(10%vs.39%,p=0.029)。两组导尿时间无差异,尿潴留,排尿困难,以及切除的淋巴结数量和主动脉旁复发率。
结论：NSPALND能显著降低急性肠梗阻的发生率，改善术后肠功能。定位SHP并将其用作解剖标志以揭示主动脉旁神经是可行的。其确切临床价值有待进一步研讨。
