背景:这项研究介绍并比较了一种新的腹膜内腹腔镜主动脉旁淋巴结切除术方法,以达到肾静脉的水平,“帐篷俯仰”顺行法与逆行法在妇科恶性肿瘤手术中的成功率方面,并发症发生率,以及切除的淋巴结数目.它侧重于可行性,安全,和有效性。同时,本文报道了在主动脉旁区域发现的血管解剖变异,以提高手术安全性。
方法:这是一项回顾性队列研究,包括2020年1月至2023年12月在单中心接受腹腔镜主动脉旁淋巴结切除术治疗高危子宫内膜癌和早期卵巢癌的患者。检查患者图表的操作方式,围手术期并发症,操作细节,和组织病理学。根据手术方式分为顺行组和逆行组。根据肾静脉水平淋巴结清除成功率进一步比较两组,围手术期并发症,以及切除的淋巴结数目.定量数据采用t检验进行分析,使用秩和检验的非正态分布数据,和分类数据使用Fisher精确检验和卡方检验,统计学意义定义为P<0.05。
结果:在173名患者中,顺行组手术成功率较高(97.5%vs68.82%),更多的淋巴结切除(中位数14vs7),减少中位失血。顺行组手术时间较短。顺行组术后并发症如淋巴囊肿和静脉血栓形成较低。28.9%的患者发现血管异常,以副腰静脉路径异常和副肾动脉最常见。
结论:顺行方法是可行的,安全,而且有效,改善手术暴露,在没有额外器械或穿刺部位的情况下降低难度,并将器官损伤风险降至最低。与逆行方法相比,它可以有效地更好地进入肾静脉并去除更多的主动脉旁淋巴结。认识到并认真管理主动脉旁区域的各种血管异常,包括肾动脉的变异,静脉,和下腔静脉,对于减少术中出血和转换为开放手术的可能性至关重要。
BACKGROUND: This study introduces and compares a new intraperitoneal laparoscopic para-aortic lymphadenectomy method to reach the level of the renal vein, the \"tent-pitching\" antegrade approach with the retrograde approach in gynecological malignancy surgeries in terms of success rate, complication incidence, and the number of lymph nodes removed. It focuses on the feasibility, safety, and effectiveness. Meanwhile, this article reports on the vascular anatomical variations discovered in the para-aortic region to enhance surgical safety.
METHODS: This was a retrospective cohort study including patients undergone laparoscopic para-aortic lymphadenectomy at a single center from January 2020 to December 2023 for high-risk endometrial and early-stage ovarian cancer. Patient charts were reviewed for mode of operation, perioperative complications, operative details, and histopathology. The patients were divided into anterograde group and retrograde group according to the operation mode. The two groups were further compared based on the success rate of lymph node clearance at the renal vein level, perioperative complications, and the number of removed lymph nodes. Quantitative data were analyzed using the t-test, non-normally distributed data using the rank-sum test, and categorical data using Fisher\'s exact test and the chi-square test, with statistical significance defined as P < 0.05.
RESULTS: Among 173 patients, the antegrade group showed higher surgery success (97.5% vs 68.82%), more lymph nodes removed (median 14 vs 7), and less median blood loss. The operation time was shorter in the antegrade group. Postoperative complications like lymphocele and venous thrombosis were lower in the antegrade group. Vascular abnormalities were found in 28.9% of patients, with accessory lumbar vein routing anomaly and accessory renal arteries being most common.
CONCLUSIONS: The antegrade approach is feasible, safe, and effective, improving surgical exposure, reducing difficulty without additional instruments or puncture sites, and minimizing organ damage risk. It is effective in achieving better access to the renal vein and removing more para-aortic lymph nodes than the retrograde method. Recognizing and carefully managing the diverse vascular abnormalities in the para-aortic area, including variations in renal arteries, veins, and the inferior vena cava, is essential to reduce intraoperative bleeding and the likelihood of converting to open surgery.