妇科恶性肿瘤腹膜后淋巴结切除术路径、要点及并发症防治.docxVIP

妇科恶性肿瘤腹膜后淋巴结切除术路 径、要点及并发症防治 蒋芳向阳 中国医学科学院北京协和医院妇产科 摘要： 腹膜后（包括盆腔和腹主动脉旁）淋巴结切除在妇科恶性肿瘤的治疗屮有重要 的作用，常见的手术路径包括经腹腔路径和腹膜外路径。手术路径的选择取决于 疾病治疗的整体方式、患者的特点和手术庾师的技术特点。手术需要由有经骑的 妇科肿瘤医师实施。术中及术后近期并发症包括血管损伤、输尿管损伤、肠管损 伤、神经损伤、围手术期感染，远期并发症最常见的是术后淋巴囊肿和下肢淋巴 水刖I。在淋巴囊肿和下肢淋巴水肿的预防中，应注意术后开放后腹膜，尽量避免 使用引流管及合理使用能量器械等。 关键词： 妇科肿瘤;盆腔淋巴结切除;腹主动脉旁淋巴结切除;并发症; 作者简介：向阳，电子信箱:xiangy@pumch. on 收稿日期：2017-08-19 Route and main points of retroperitoneal lymph node dissection for gynecological malignancies and the prevention and treatment of complications JIANG Fang XIANG Yang Department of Obste^xl^and^Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences; Abstract： Retroperitonceil lymph node disscction, including pelvic and para-aortic lymphadenectom^s is of great importance in gynecological malignancies treatment. Lymphadenectomy can be performed via transperitoneal or extraperitoneal route. The surgical approach used for a lymphadenectomy procedure in gynecological oncology is typical1y determined by the best approach for the total procedure, patient characteristics and surgcon，s experience. Surgery needs to be operated by an experienced gynecologic oncologist. The most frequent intraoperative and postoperative complication is vascular injury, followed by ureteral injury, bowel injury, neurologic injury, or perioperative infcction. Latc-postopcrativc complications consist mainly of symptomatic lymphatic lymphocyte (SPOL) and lower extremity lymphedema (LEL) ? Several techniques may decrease the incidence of SPOL and LEL. Thus, energy equipment should be rationally used during the procedure, the peritoneum should be left open and tube drains should be avoided. Keyword： gynecological malignancy; pelvic lymphadenectomy; paraaortic lymphadenectomy; complicition; Received： 2017-08-19 手术是多种妇科恶性肿瘤的主要治疗方式，腹膜后(包括盆腔和腹主动脉旁) 淋巴结切除在妇科恶性肿瘤的治疗屮有着重要的作用。在子宫内膜癌、卵巢癌和 早期宫颈癌的手术中，腹膜后淋巴结切除是手术的组成部分。 在非手术治疗的宫颈癌患者中，淋巴结转移情况是重要的预后因素，并影响进 一步的治疗决策，对部分选择性病例，腹膜后淋巴结切除同样是治疗评估的重 要步骤