本研究介绍并比较了腹腔镜腹主动脉旁淋巴结清扫至肾静脉水平的新方法——“搭帐篷”顺行入路与逆行入路在妇科恶性肿瘤手术中的成功率、并发症发生率和手术效果。切除的淋巴结数量。重点关注可行性、安全性、有效性。同时，本文报告了在主动脉旁区域发现的血管解剖变异，以提高手术安全性。这是一项回顾性队列研究，包括2020年1月至2023年12月在单中心接受腹腔镜主动脉旁淋巴结切除术的高危患者子宫内膜癌和早期卵巢癌。审查患者病历的手术方式、围手术期并发症、手术细节和组织病理学。根据手术方式将患者分为顺行组和逆行组。进一步比较两组肾静脉水平淋巴结清除成功率、围手术期并发症以及清除淋巴结数量。定量数据采用t检验，非正态分布数据采用秩和检验，分类数据采用Fisher精确检验和卡方检验，统计显着性定义为P<0.05。在173名患者中，顺行组的手术成功率较高（97.5% vs 68.82%），切除的淋巴结较多（中位 14 个 vs 7 个），中位​​失血量较少。顺行组的手术时间较短。顺行组中淋巴囊肿和静脉血栓形成等术后并发症较低。 28.9%的患者发现血管异常，其中副腰静脉走行异常和副肾动脉最为常见。顺行入路可行、安全、有效，可改善手术暴露，减少难度，无需额外器械或穿刺部位，最大限度减少手术风险。器官损伤风险。与逆行法相比，它可以更有效地进入肾静脉并切除更多的主动脉旁淋巴结。认识并仔细处理主动脉旁区域的各种血管异常，包括肾动脉、静脉和下腔静脉的变化，对于减少术中出血和转为开腹手术的可能性至关重要。© 2024 ）。斯堪的纳维亚妇产科学报，约翰·威利 (John Wiley) 出版

This study introduces and compares a new intraperitoneal laparoscopic para-aortic lymphadenectomy method to reach the level of the renal vein, the "tent-pitching" antegrade approach with the retrograde approach in gynecological malignancy surgeries in terms of success rate, complication incidence, and the number of lymph nodes removed. It focuses on the feasibility, safety, and effectiveness. Meanwhile, this article reports on the vascular anatomical variations discovered in the para-aortic region to enhance surgical safety.This was a retrospective cohort study including patients undergone laparoscopic para-aortic lymphadenectomy at a single center from January 2020 to December 2023 for high-risk endometrial and early-stage ovarian cancer. Patient charts were reviewed for mode of operation, perioperative complications, operative details, and histopathology. The patients were divided into anterograde group and retrograde group according to the operation mode. The two groups were further compared based on the success rate of lymph node clearance at the renal vein level, perioperative complications, and the number of removed lymph nodes. Quantitative data were analyzed using the t-test, non-normally distributed data using the rank-sum test, and categorical data using Fisher's exact test and the chi-square test, with statistical significance defined as P < 0.05.Among 173 patients, the antegrade group showed higher surgery success (97.5% vs 68.82%), more lymph nodes removed (median 14 vs 7), and less median blood loss. The operation time was shorter in the antegrade group. Postoperative complications like lymphocele and venous thrombosis were lower in the antegrade group. Vascular abnormalities were found in 28.9% of patients, with accessory lumbar vein routing anomaly and accessory renal arteries being most common.The antegrade approach is feasible, safe, and effective, improving surgical exposure, reducing difficulty without additional instruments or puncture sites, and minimizing organ damage risk. It is effective in achieving better access to the renal vein and removing more para-aortic lymph nodes than the retrograde method. Recognizing and carefully managing the diverse vascular abnormalities in the para-aortic area, including variations in renal arteries, veins, and the inferior vena cava, is essential to reduce intraoperative bleeding and the likelihood of converting to open surgery.© 2024 The Author(s). Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).