| ObjectiveTesticular cancer is a common malignancy in young men 15 to 45 years old. Currently, testicular germ cell tumors have been through a multidisciplinary approach, combined treatment method successfully treated, the overall survival rate of 90%. Since KOCHER 1887 first described the testicular cancer patients retroperitoneal tumor resection, surgical treatment has been part of testicular germ cell tumor comprehensive treatment. Many patients with positive lymph nodes after possible by retroperitoneal lymph node dissection( RPLND) to be cured. However, a large open RPLND trauma, while the use of laparoscopic retroperitoneal lymph node dissection(L-RPLND) can significantly reduce surgical trauma, open surgery can achieve the same therapeutic effect. Subjects and methodsFollow randomized experimental methods, the 22 cases of testicular non-seminoma patients were randomly divided into two groups, 11 cases of laparoscopic surgery group, aged 21 to 33 years, mean age 28 years, 11 cases of open surgery group, age 23 to 34 years, mean 30 years old. First 22 patients underwent preoperative blood count, electrolytes, liver and kidney function and tumor markers large full inspection, including serum alpha-fetoprotein(AFP)(normal<10ng/ml), human chorionic film gonadotropin(?-HCG)(normal<5.0mIU/L)(2 cases teratoma ?-HCG prompt negative); intraperitoneal and pelvic CT or MRI, which 18 cases of lymph node-positive tips, four cases prompted highly suspected retroperitoneal lymph node metastasis, 4 cases of this anti-inflammatory treatment of one week, after the inspection, suggesting no significant change in the lymph nodes, lymph node metastasis can be determined. Check no obvious contraindications to surgery patients before surgery, 2 patients were taken to laparoscopic and open surgical treatment, after statistical analysis by number of lymph node dissection operative time, blood loss, and postoperative gastrointestinal function recovery time, the average postoperative hospital stay and postoperative complications, comparing two surgical outcome. Results11 cases of laparoscopic surgery were changed to open surgery, no postoperative complications, average intraoperative blood loss(99±15)ml, surgery without blood transfusion, mean operative time(159±32) min, lymph nodes The number of cleaning(15±4), average hospital stay(7.2±2.6)d, months postoperative gastrointestinal function recovery time(1.5±0.4) d.Open 11 cases were operated smoothly, no change in surgical approach, average intraoperative blood loss(215±30) ml, mean operative time(169±36) min, the number of lymph node dissection(16±3), average hospital stay of patients after surgery(12.8±4.0) d, months after surgery gastrointestinal function recovery time(2.5±0.7) d, One patient incision did not heal after7 days, nutritional support therapy and regular dressing changes, about 15 days after the wound healing; 1 patient chills, fever, give the relevant examination, symptomatic use of antibiotics, the body temperature gradually returned to normal.The average operation time two groups(t=0.688, p=0.511), number of lymph node dissection(t=0.509, p=0.601) were not statistically different; blood loss(t=10.779, p <0.001), postoperative gastrointestinal function recovery time(t=3.413, p=0.003), mean postoperative hospital stay time(t=2.881, p=0.009) were significantly different; open group were 2 cases of complications of laparoscopic surgery group after no complications. ConclusionLaparoscopic 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 diagnosis and treatment of clinical stage ?-? nonseminomatous cell tumor. |
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