Objective: To explore the change and feasibility of surgical techniques of laparoscopic transhiatal(TH)-lower mediastinal lymph node dissection(LMLND) for adenocarcinoma of the esophagogastric junction(AEG)according t...Objective: To explore the change and feasibility of surgical techniques of laparoscopic transhiatal(TH)-lower mediastinal lymph node dissection(LMLND) for adenocarcinoma of the esophagogastric junction(AEG)according to Idea, Development, Exploration, Assessment, and Long-term follow-up(IDEAL) 2a standards.Methods: Patients diagnosed with AEG who underwent laparoscopic TH-LMLND were prospectively included from April 14, 2020, to March 26, 2021. Clinical and pathological information as well as surgical outcomes were quantitatively analyzed. Semistructured interviews with the surgeon after each operation were qualitatively analyzed.Results: Thirty-five patients were included. There were no cases of transition to open surgery, but three cases involved combination with transthoracic surgery. In qualitative analysis, 108 items under three main themes were detected: explosion, dissection, and reconstruction. Revised instruction was subsequently designed according to the change in surgical technique and the cognitive process behind it. Three patients had anastomotic leaks postoperatively, with one classified as Clavien-Dindo Ⅲa.Conclusions: The surgical technique of laparoscopic TH-LMLND is stable and feasible;further IDEAL 2b research is warranted.展开更多
目的探讨早期宫颈癌、子宫内膜癌、卵巢癌术中保留腹股沟深淋巴结是否可以减轻术后下肢淋巴水肿。方法采用前瞻性随机对照研究设计,纳入2022年7月~2023年7月早期宫颈癌、子宫内膜癌、卵巢癌100例,随机分为保留组(保留腹股沟深淋巴结,n=...目的探讨早期宫颈癌、子宫内膜癌、卵巢癌术中保留腹股沟深淋巴结是否可以减轻术后下肢淋巴水肿。方法采用前瞻性随机对照研究设计,纳入2022年7月~2023年7月早期宫颈癌、子宫内膜癌、卵巢癌100例,随机分为保留组(保留腹股沟深淋巴结,n=50)和切除组(切除腹股沟深淋巴结,n=50)。均由同一手术团队行根治性手术。术后1、2、6、12个月评估下肢淋巴水肿情况,采用妇科恶性肿瘤淋巴水肿问卷(Gynecologic Cancer Lymphedema Questionnaire,GCLQ)和下肢周径测量进行诊断。结果保留组下肢淋巴水肿发生率6%(3/50),显著低于切除组的20%(10/50)(χ^(2)=4.332,P=0.037),且发生时间较晚[(5.3±3.1)月vs.(2.3±1.6)月,t=2.394,P=0.036],2组下肢淋巴水肿分期和部位差异无显著性(P>0.05)。结论在早期宫颈癌、子宫内膜癌及卵巢癌手术中保留腹股沟深淋巴结可显著降低术后下肢淋巴水肿的发生率。展开更多
基金supportedbyBeijing Municipal Administration of Hospitals(No.DFL20181103)Beijing Hospitals Authority Innovation Studio of Young Staff Funding Support(No.202123).
文摘Objective: To explore the change and feasibility of surgical techniques of laparoscopic transhiatal(TH)-lower mediastinal lymph node dissection(LMLND) for adenocarcinoma of the esophagogastric junction(AEG)according to Idea, Development, Exploration, Assessment, and Long-term follow-up(IDEAL) 2a standards.Methods: Patients diagnosed with AEG who underwent laparoscopic TH-LMLND were prospectively included from April 14, 2020, to March 26, 2021. Clinical and pathological information as well as surgical outcomes were quantitatively analyzed. Semistructured interviews with the surgeon after each operation were qualitatively analyzed.Results: Thirty-five patients were included. There were no cases of transition to open surgery, but three cases involved combination with transthoracic surgery. In qualitative analysis, 108 items under three main themes were detected: explosion, dissection, and reconstruction. Revised instruction was subsequently designed according to the change in surgical technique and the cognitive process behind it. Three patients had anastomotic leaks postoperatively, with one classified as Clavien-Dindo Ⅲa.Conclusions: The surgical technique of laparoscopic TH-LMLND is stable and feasible;further IDEAL 2b research is warranted.
文摘目的探讨早期宫颈癌、子宫内膜癌、卵巢癌术中保留腹股沟深淋巴结是否可以减轻术后下肢淋巴水肿。方法采用前瞻性随机对照研究设计,纳入2022年7月~2023年7月早期宫颈癌、子宫内膜癌、卵巢癌100例,随机分为保留组(保留腹股沟深淋巴结,n=50)和切除组(切除腹股沟深淋巴结,n=50)。均由同一手术团队行根治性手术。术后1、2、6、12个月评估下肢淋巴水肿情况,采用妇科恶性肿瘤淋巴水肿问卷(Gynecologic Cancer Lymphedema Questionnaire,GCLQ)和下肢周径测量进行诊断。结果保留组下肢淋巴水肿发生率6%(3/50),显著低于切除组的20%(10/50)(χ^(2)=4.332,P=0.037),且发生时间较晚[(5.3±3.1)月vs.(2.3±1.6)月,t=2.394,P=0.036],2组下肢淋巴水肿分期和部位差异无显著性(P>0.05)。结论在早期宫颈癌、子宫内膜癌及卵巢癌手术中保留腹股沟深淋巴结可显著降低术后下肢淋巴水肿的发生率。
