腹腔镜para-Aortic淋巴结清扫术的改善和挑战：新型的“帐篷”前进方法和para-Aortic区域的血管解剖学变异

这项研究介绍并比较了一种新的腹膜内腹腔镜para-Aortic淋巴结清扫术方法，以达到肾静脉的水平，即在妇科恶性肿瘤手术中的“帐篷”前进方法与逆行方法，以继承率，并发率，复杂性发生率和lympher nodes nodes的数量。它着重于可行性，安全性和有效性。同时，本文报道了在Para-Aortic区域发现的血管解剖学变异，以提高手术安全性。这是一项回顾性同类研究，包括在2020年1月2020年1月2020年12月至2023年12月，在2020年12月2020年12月，对高现实的Oramometrical和早期的癌症癌症的腹腔镜para-Aortic para淋巴结式术进行了腹腔镜淋巴结术。对患者图表进行了审查，以进行操作模式，围手术期并发症，手术细节和组织病理学。根据手术模式将患者分为顺行组和逆行组。根据肾静脉水平，围手术期并发症和去除的淋巴结的数量在肾静脉水平上的淋巴结清除率的成功率进一步比较这两组。 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.在流行组中，操作时间短。术后并发症（如淋巴细胞和静脉血栓形成）在流行组中较低。在28.9％的患者中发现了血管异常，腰椎静脉静脉路线异常和辅助肾动脉最为常见。流行方法是可行的，安全的，有效的，有效的，改善手术的暴露，在没有其他仪器或刺激器官损害的情况下减少困难，并减少难度。与逆行方法相比，它可以有效地实现更好地进入肾静脉并去除更多的Para-Aertic淋巴结。认识并仔细管理para-Aortic区域中多种血管异常，包括肾动脉，静脉和下腔静脉的变化，对于降低术中出血以及转化为开放手术的可能性是必不可少的。

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.