摘要
目的 探讨腹腔镜下保留神经腹膜后淋巴结清除术治疗早期睾丸肿瘤的疗效及安全性.方法 2001年1月至2014年9月收治睾丸肿瘤患者83例.年龄18 ～44岁,平均25岁.均无射精功能障碍.根治性睾丸切除术前甲胎蛋白15 ～1 432 μg/L,平均874 μg/L;人绒毛膜促性腺激素5～70 IU/L,平均56 IU/L.肿瘤术前临床分期均为Ⅰ期.根治性睾丸切除术后病理诊断均为非精原细胞瘤.术后1～4周行腹腔镜下保留神经腹膜后淋巴结清扫术.结果 本组83例腹腔镜下保留神经腹膜后淋巴结清扫术均顺利完成.手术时间158～285 min,平均218 min;术中出血量255～ 587 ml,平均368ml;术后肠功能恢复时间24 ～48 h,平均31h;住院时间5～9d,平均7d.术中发生下腔静脉损伤1例,于腹腔镜下缝合.3例术后出现轻微乳糜性腹膜后引流液,予限制脂肪性饮食,术后1周内乳糜漏消失.22例术后出现射精功能障碍,未特殊干预,均于术后8 ～ 12周恢复.73例随访3～ 76个月,平均27个月,无肿瘤复发或转移.结论 腹腔镜下保留神经腹膜后淋巴结清扫技术可行,创伤小、并发症少、术后恢复快,对于有保留生育要求的患者是治疗低分期非精原细胞瘤的首选方法.
Objective To evaluate of efficacy and safety of nerve sparing laparoscopic retroperitoneal lymph node dissection for early stage testicular cancer.Methods From January 2001 to September 2014,83 patients with primary testicular nonseminomatous germ cell tumors （NSGCT） received nerve sparing LRPLND at 1-4 week after orchiectomy.Their age ranged from 18 to 44 years old,mean 25 years old.Serum AFP was abnormally elevated in 51 patients,ranged from 15to 1432μg/L （mean 874 μg/L） beta-HCG were abnormally elevated in 46 patients,ranged from 5-70 IU/L （mean 56 IU/L）.All of their clinical stage was stage Ⅰ and did not suffer from ejaculatory dysfunction.The operating time,intraoperative blood loss,postoperative intestinal function recovery time,drainage removal time,hospital stay,intra-and post-operative complications were recorded.Results The nerve sparing laparoscopic retroperitoneal lymph was successfully performed in all patients.The mean operating time was 218 min,（range 158-285 min）.The mean intraoperative blood loss was 368ml （range 255-587ml）.The postoperative intestinal function recovery time ranged from 24 to 48 hours （mean 31 hours）.And the hospital stay ranged from 5 to 9 days （mean 7days）.The inferior vena cava was injured during operation and was sutured laparoscopically in 1 patient.Mild chylous retroperitoneal drainage was seen in 3 patients,which was cured within 1 week after operation by restriction of high-fat diet.22 cases were noticed ejaculation dysfunction postoperatively,which recovered spontaneously within 8 to 12 weeks.Within the 3 to 76 months follow-up,73 patients revealed no evidence of recurrence or distant metastasis.Conclusions Nerve sparing LRPLND is technically feasible,mini invasive,the morbidity and complication were significantly lower.It can be performed with satisfactory results in young patients with early stage NSGCT.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2015年第5期357-360,共4页
Chinese Journal of Urology
关键词
睾丸
非精原细胞肿瘤
保留神经腹膜后淋巴结清扫术
腹腔镜
射精
Testicle
Nonseminomatous germ cell tumors
Nerve sparing retroperitoneal lymph node dissection
Laparoscopy
Ejaculation
