单孔腹腔镜UGF两翼法腹主动脉旁淋巴结切除术

doi:10.3877/cma.j.issn.1674-6899.2023.04.010

目的

总结单孔腹腔镜泌尿生殖筋膜(urogenital fascia，UGF)两翼法腹主动脉旁淋巴结切除术在子宫内膜癌手术治疗中的临床效果及优势。

方法

回顾性分析2023年7月在武汉大学中南医院妇科的1例行经脐单孔腹腔镜子宫内膜癌分期手术的患者临床资料。患者术前诊断：子宫内膜样腺癌ⅠB期(G3)，子宫肌瘤，2型糖尿病，贫血(轻度)。行单孔腹腔镜腹主动脉旁淋巴结切除术、盆腔淋巴结切除术、筋膜外子宫切除术及双侧输卵管卵巢切除术。

结果

患者手术顺利，未加辅助孔，术中出血量少，术后无感染、出血、乳糜漏等并发症，恢复顺利。

结论

单孔腹腔镜UGF两翼法腹主动脉旁淋巴结切除术因为良好的术野暴露，可以显著降低腹主动脉旁淋巴结切除术手术难度，同时降低术中对周围脏器的副损伤，减少术后并发症。

关键词: 子宫内膜癌, 泌尿生殖筋膜, 腹主动脉旁淋巴结切除

Objective

To summarize the clinical effect and advantage of single-port laparoscopic UGF two-wings para-aortic lymphadenectomy on the treatment of endometrial carcinoma.

Methods

A retrospective analysis was conducted of 1 patients with endometrial carcinoma in stage IB (G3) from the Zhongnan Hospital of Wuhan University on Jul. 2023.The patient was diagnosed as endometrioid adenocarcinoma stage IB (G3), uterine fibroids, type 2 diabetes mellitus and anemia (mild). Single-port laparoscopic para-aortic lymphadenectomy, pelvic lymphadenectomy, epifascial hysterectomy, and bilateral salpingo-oophorectomy were performed.

Results

The surgery went well. Intraoperative bleeding was low during surgery and no postoperative complications such as infection, bleeding, and celiac leakage. Patient recovering well after surgery.

Conclusion

For the reason that good surgical field exposure, single-port laparoscopic UGF two-wings para-aortic lymphadenectomy can not only greatly reduce the difficulty of para-aortic lymphadenectomy, but also reduce both the collateral damage to peripheral organs during surgery and reduce postoperative complications.

Key words: Endometrial cancer, Urogenital fascia, Para-aortic lymphadenectomy

图1 右侧UGF暴露注：A.分离UGF后叶见输尿管及卵巢血管；B.进一步向上分离十二指肠达左肾静脉；C．显露右侧卵巢静脉汇入下腔静脉；D.右侧UGF。

图2 左侧UGF暴露注：A.左侧髂血管上方，输尿管旁切开后腹膜；B.乙状结肠外侧左侧UGF；C.沿左肾静脉分离出左侧卵巢静脉；D．左侧UGF。

图3 腹主动脉旁淋巴结切除注：A.腹主动脉旁高位淋巴结切除；B.腹主动脉旁低位淋巴结切除；C.腹主动脉旁淋巴结切除术后观。

1	Crosbie EJ, Kitson SJ, McAlpine JN, et al. Endometrial cancer[J]. Lancet, 2022, 399(10333)：1412-1428.
2	Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3)：209-249.
3	Kim NR, So KA, Kim TJ, et al. Role of systematic lymphadenectomy in patients with intermediate to high-risk early stage endometrial cancer[J]. J Gynecol Oncol, 2023, 34(3)：e23.
4	Legros M, Margueritte F, Tardieu A, et al. Para-aortic lymph node invasion in high-risk endometrial cancer: performance of 18 FDG PET-CT[J]. Anticancer Res, 2019, 39(2)：619-625.
5	黄莉，雷婷，郭宏涛，等. 淋巴绘图下的腹主动脉旁淋巴结切除术[J/CD]. 中华腔镜外科杂志(电子版), 2021, 14(5)：315-317.
6	Li Y, Ma YB, Xiao Y, et al. The characteristics of the urogenital fascia in the retrorectal space based on male cadaveric dissection and its clinical application[J]. BMC Surg, 2023, 23(1)：93.
7	Li Y, Zhao YM, Ma YB, et al. The "Y" -shaped Denonvilliers′ fascia and its adjacent relationship with the urogenital fascia based on a male cadaveric anatomical study[J]. BMC Surg, 2023, 23(1)：13.
8	Zhou Z, Yan L, Li Y, et al. Embryonic developmental process and clinical anatomy of the preperitoneal fascia and its clinical significance[J]. Surg Radiol Anat, 2022, 44(12)：1531-1543.
9	Li Y, Qin C, Yan L, et al. Urogenital fascia anatomy study in the inguinal region of 10 formalin-fixed cadavers: new understanding for laparoscopic inguinal hernia repair[J]. BMC Surg, 2021, 21(1)：295.
10	Wedel T, Heimke M, Fletcher J, et al. The retrocolic fascial system revisited for right hemicolectomy with complete mesocolic excision based on anatomical terminology: do we need the eponyms Toldt, Gerota, Fredet and Treitz？[J]. Colorectal Dis, 2023, 25(4)：764-774.

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Single-port laparoscopic UGF two-wings para-aortic lymphadenectomy

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Single-port laparoscopic UGF two-wings para-aortic lymphadenectomy