A New Retroperitoneal Lymph Node Dissection In The Treatment Of Gynecologic Malignancies

Research Background：Lymph node metastasis is common metastatic in patients with gynecologicalmalignancies.Make clear the status of retroperitoneal lymph node is Meaningful forpatients in the diagnosis of gynecologic malignancies, tumor staging and prognosisvalue clear. It is may be useful for the survival rate of cancer patients. When we cut offthe original tumor and metastases resection,we should not ignore the retroperitoneallymph node at the same time.The surgical of retroperitoneal lymph node dissection include extraperitoneal andintraperitoneal lymph node dissection. Traditional lymph node dissection that theclippers law retroperitoneal lymph node dissection use scissors instrument to cutvascular sheath.It is complex technical, more difficult, more dangerous, longer operativetime and difficult to master. And traditional surgical remove the lymph nodes, therelated capillary lymphatic vessels and lymphatic vessels. The body’s lymphaticdrainage pathway is destructed. After pelvic lymphodes dissection the pelviclymphocele is easy to form.The incidence of pelvic lymphocele fluctuate from4.3%to48%. The pelviclymphocele bring great harm to the physical and mental health for patients.So weshould try to avoid the formation of lymphocele. Lymphatic vessels and lymph nodeswith metastatic cancer can block the lymphatic normal drainage pathway.Cancer cellscan spread to non-normal lymphatic drainage path through the lymphatic collateralcirculation or reverse osmosis. But it can not stimulate the newborn lymphformation.Therefore it is feasible to retain the lymphatic system.If only resection of regional lymph node and try to retain the basic structure of the lymphatic drainage system, whether it can rely on the patient’s own repair and effectivein preventing the formation of lymph cyst? Whether it can effectively simplify thesurgical procedure to reduce the difficulty of operation, shorten the operation time?Based on the above issues, we originated a new peritoneal lymph node dissection. Thenew peritoneal lymph node dissection was named emblem positioning retrograderetroperitoneal lymph node dissection. The purpose of the new technique was onlyexcising lymph node tissue.It is can be minimizing damage to the lymphatic system andblood vessels.The new peritoneal lymph node also can reduce the incidence of thepelvic lymphocele after pelvic lymphnodes dissection.Objective：To simplify the surgical procedure、shorter operative time and reduce the incidenceof the pelvic lymphocele,we originated a new peritoneal lymph node dissection.Thenew peritoneal lymph node dissection can reduce the damage of the lymphatic andvascular sheath organizations. In the research,we should demonstrate the feasibility,safety, and the superiority of the new surgical from a theoretical and clinical.Method：100cases who received abdominal pelvic lymphadenectomy collected in ourhospital from January2011to December2012.The patients was completed the surgicalby the surgeon of the same group. According to the retroperitoneal lymph nodedissection technique different,the patients were divided into a control group and astudy group.50patients of the study group were treated by a new peritoneal lymphnode dissection.50patients of the control group were underwent the traditional surgical.The clinical data (such as age, malignant tumor type, stage, etc) and the surgery-relateddata(lymph node dissection, blood loss, number of lymph node dissection, the incidenceof lymphocele, intraoperative and postoperative complication rate) of the two sets werecollected. The average operation time, average blood loss,the number of lymphnodes,pelvic drainage,hospital days, postoperative complications were compared between two groups.Result：Comparison of the study group and the control group in operation.The operativetime was shorter in the study group.The difference between the two groups wassignificant statistically signifcant(P <0.01).Comparison of the study group and the control group in operation and afteroperation.The number of pelvic lymph nodes(including the left side, the right side of thepelvic lymph node dissection) were more in the study group.The difference between thetwo groups was significant statistically signifcant(P <0.01).The difference of thenumber of the presacral area and para-aortic lymphadenectomy between the two groupswas statistically non-significance(P>0.05).Compare with the control group,the incidence of postoperative lymphocele ofstudy group(12.0%,6/50) were lower.The difference between the two he two groupswas significant statistically signifcant(P <0.01).Postoperative urination recovery time,vascular injury, ureteral injury, urinary retention,DVT,the difference between the twogroups was statistically non-significance(P>0.05).Conclusion：The new retroperitoneal lymph node dissection can shorten the operation time,simplify the surgical procedure to reduce the difficulty of operation.The new retroperitoneal lymph node dissection can increase the number of lymphnodes, significantly reduce postoperative lymphocele formation rate.At the same timethe new surgical does not increase the incidence of intraoperative and postoperativecomplications.