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目的探讨腹腔镜腹膜后淋巴结清扫术的临床可行性,并总结手术技巧。方法对9例睾丸非精原细胞瘤型生殖细胞瘤患者,行根治性睾丸切除术后平均27d行改良腹膜后径路腹腔镜腹膜后淋巴结清扫术。结果 9例手术均获成功,术中发生下腔静脉损伤1例,腹腔镜下缝合。平均手术时间170min,平均出血量330ml,术后肠功能恢复时间约2d,引流管均于术后第3天拔除,平均住院时间7d。术后随访分别为18±8个月,无复发及转移。结论经改良腹膜后径路行腹腔镜腹膜后淋巴结清扫可避免对腹腔脏器的影响,解剖结构显露较满意,具有创伤小、恢复快等优点,是一种临床可进一步应用的手术方式。
Objective To investigate the clinical feasibility of laparoscopic retroperitoneal lymph node dissection and to summarize the surgical techniques. Methods Nine patients with testicular nonseminomas germinoma were treated with modified retroperitoneal laparoscopic retroperitoneal lymph node dissection after radical orchiectomy for an average of 27 days. Results All the 9 surgeries were successful. One case of inferior vena cava injury occurred during operation and laparoscopic suture was performed. The average operation time was 170min and the average amount of bleeding was 330ml. The recovery time of intestinal function after operation was about 2 days. The drainage tubes were both removed on the third day and the average length of stay was 7 days. Postoperative follow-up was 18 ± 8 months, no recurrence and metastasis. Conclusions The laparoscopic retroperitoneal lymph node dissection through the retroperitoneal approach can avoid the influence on the abdominal viscera. The anatomic structure is more satisfactory and has the advantages of less trauma and quicker recovery. It is a surgical method that can be further applied clinically.