腹腔镜下腹膜后淋巴结清扫术治疗临床Ⅰ期睾丸非精原细胞肿瘤7例报告

张东旭; 崔心刚; 李勋钢; 陈杰; 王军凯; 李尧; 陈露; 汪凯; 徐丹枫

腹腔镜下腹膜后淋巴结清扫术治疗临床Ⅰ期睾丸非精原细胞肿瘤7例报告

- 第二军医大学附属长征医院泌尿外科, 全军泌尿外科中心(上海, 200003)

详细信息

通讯作者: 徐丹枫,E-mail:xu-danfeng@hotmail.com

中图分类号: R697

收稿日期: 2012-01-08

Laparoscopic retroperitoneal lymph node dissection for clinical stageⅠnonseminomatous germ cell tumor (Report of 7 cases)

- Department of Urology, Changzheng Hospital of Second Military Medical University, Shanghai, 200003, China

More Information

Corresponding author: XU Danfeng, E-mail: xu-danfeng@hotmail.com

Received Date: 08 January 2012

摘要

摘要: 目的：探讨腹腔镜下腹膜后淋巴结清扫术治疗临床Ⅰ期睾丸非精原细胞肿瘤的临床经验及疗效。方法：回顾性分析2008年10月~2011年6月7例睾丸非精原细胞癌的临床资料，其中左侧4例，右侧3例，平均年龄（34±11）岁，胚胎癌5例，混合性生殖细胞肿瘤2例。术前临床分期均为I期；7例患者均在根治性睾丸切除术后1周行腹腔镜下腹膜后淋巴结清扫术。结果：所有手术均顺利完成，无中转开放，围手术期无严重并发症。平均手术时（172±35） min，术中平均出血量（43±14） ml，平均切除淋巴结（12±3）个，淋巴结阳性患者2例。术后平均住院时间（6±2） d，术后平均随访（25±10）个月，所有患者术后射精功能正常，肿瘤无局部复发及远处转移。结论：腹腔镜下腹膜后淋巴结清扫术安全、有效，具有创伤小、恢复快等优点，可作为明确诊断和治疗临床Ⅰ期睾丸非精原细胞肿瘤的首选方法。
- 睾丸 /
- 非精原细胞肿瘤 /
- 腹腔镜 /
- 腹膜后淋巴结清扫术
Abstract: Objective: To study the clinical experiences and effects of laparoscopic retroperitoneal lymph node dissection for clinical stage I nonseminomatous germ cell tumor.Method: From October 2008 to June 2011,7 cases of nonseminomatous germ cell tumor(embryonal tumor in 5 cases and mixed germ cell tumor in 2 cases)were retrospectively analyzed.Mean age was(34±11)years,with 4 case on the left side and 3 cases on the right side.All of the 7 patients received laparoscopic retroperitoneal lymph node dissection one week after radical orchiectomy.Result: 7 cases were operated successfully without conversion to open surgery,no severe perioperative complications.The mean operation time was(172±35)min,and mean blood loss was(43±14)ml;the mean dissected lymph node number was(12±3),and active tumor was found in retroperitoneal lymph node dissection specimens in 2 cases.Mean postoperative hospital stay was(6±2)days,in a mean follow up for(25±10)months,all patients with normal antegrade ejaculation,no local tumor recurrence and distant metastasis during follow-up.Conclusion: laparoscopic retroperitoneal lymph node dissection is safe and effective with less trauma and faster recovery of its advantages,and it can be used as first-line choice for the diagnosis and treatment of clinical stage Ⅰ nonseminomatous germ cell tumor.
- testicle /
- nonseminomatous germ cell tumor /
- laparoscopy /
- retroperitoneal lymph node dissection

HTML全文

参考文献(16)

[1]	ALBERS P, ALBRECHT W, ALGABA F, et al. EAU guidelines on testicular cancer:2011 update[J]. Eur Urol,2011,60:304-319.
[2]	NICOLAI N, MICELI R, ARTUSI R, et al. A simple model for predicting nodal metastasis in patients with clinical stage I nonseminomatous germ cell testicular tumors undergoing retroperitoneal lymph node dissection only[J]. J Urol,2004,17:172-176.
[3]	HOTTE S J, MAYHEW L A, JEWETT M, et al. Management of stage I non-seminomatous testicular cancer:a systematic review and meta-analysis[J]. Clin Oncol(R Coll Radiol),2010,22:17-26.
[4]	JANETSCHEK G, HOBISH A, PESCHEL R, et al. Laparoscopic retroperitoneal lymph node dissection for clinical stage I nonseminomatous testicular carcinoma:long-term outcome[J]. J Urol,2000,163:1793-1796.
[5]	NICOLAI N, MICELI R, NECCHI A, et al. Retroperitoneal lymph node dissection with no adjuvant chemotherapy in clinical stage I nonseminomatous germ cell tumours:long-term outcome and analysis of risk factors of recurrence[J]. Eur Urol,2010,58:912-918.
[6]	POULAKIS V, SKRIAPAS K, DE VRIES R, et al. Quality of life after laparoscopic and open retroperitoneal lymph node dissection in clinical stage I nonseminomatous germ cell tumor:a comparison study[J]. Urology,2006,68:154-160.
[7]	EGGENER S E, CARVER B S, SHARP D S, et al. Incidence of disease outside modified retroperitoneal lymph node dissection templates in clinical stage I or IIA nonseminomatous germ cell testicular cancer[J]. J Urol, 2007, 177:937-943.
[8]	ALLAF M E,BHAYANI S B,LINK R,et al. Laparoscopic retroperitoneal lymph node dissection:duplication of the open technique[J].Urology,2005,65:575-577.
[9]	RASSWEILER J J,SCHEITLIN W,HEIDENREICH A,et al.Laparoseopie retroperitoneal lymph node dissection:dose it still have a role in the management of clinical stage I cancer?A European perspective[J].Eur Urol,2008,54:1004-1015.
[10]	NIELSEN M E,LIMA G,SCHAEFFER E M,et al.Oncologic efficacy of laparoscopic RPLND in treatment of clinical stage I nonseminomatous germ cell testicular cancer[J].Urology,2007,70:1168-1172.
[11]	CRESSWELL J,SCHEITLIN W,GOZEN A,et al.Laparoscopic retroperitoneal lymph node dissection combined with adjuvant chemotherapy for pathological stage II disease in nonseminomatous germ cell tumours:a 15-year experience[J].BJU Int,2008,102:844-848.
[12]	KENNEY P A,TUERK I A.Complications of laparoseopie retroperitoneal lymph node dissection in testicular cancer[J].World J Urol,2008,26:561-569.
[13]	LATTOUF J B,JESCHKE S,JANETSCHEK G.Laparoscopic retroperitoneal lymph node dissection:technique[J].BJU Int,2007,100:1415-1429.
[14]	PESCHEL R,GETTMAN M T,NEURURER R,et al.Laparoscopic retroperitoneal lymph node dissection:description of the nerve-sparing technique[J].Urology,2002,60:339-343.
[15]	STEINER H,ZANGERL F,STÖHR B,et al.Results of bilateral nerve sparing laparoscopic retroperitoneal lymph node dissection for testicular cancer[J].J Urol,2008,180:1348-1353.
[16]	WILLIAMS S B,LAU C S,JOSEPHSON D Y.Initial series of robot-assisted laparoscopic retroperitoneal lymph node dissection for clinical stage I nonseminomatous germ cell testicular cancer[J].Eur Urol,2011,60:1299-1302.