What are the procedures of pelvic lymphadenectomy

summary

Pelvic lymph node dissection is an important operation, friends in the case of disease need to carry out such an operation, then, what are the steps of pelvic lymph node dissection? Let's talk about it.

What are the procedures of pelvic lymphadenectomy

Step 1: after successful anesthesia, the median or paramedian abdominal incision was removed, and the incision was 3-5 cm above the umbilicus. The skin and subcutaneous tissue were cut in turn, and the rectus abdominis was separated to expose the peritoneum. Lift the edge of the anterior sheath of the right rectus abdominis, and press the palms of the four fingers of both hands against the peritoneum to gently separate the right extraperitoneal space, so as not to damage the inferior abdominal artery and vein. The round ligament was found at the level of anterior superior iliac spine and the internal orifice of inguinal canal. The ligament was clipped off and sutured with No.7 suture. The suture was reserved at the proximal end.

Step 2: the psoas major muscle, iliac blood vessel and ureter of retroperitoneum were exposed by pulling the suture at the edge of retroperitoneum cut on the right side, and the surrounding tissues were free along the ureteral route. The upper peritoneum and abdominal wall were pulled apart by the retractor to expose the operation field. The adipose connective tissue of psoas major muscle was separated and the genitofemoral nerve was exposed. The lymphoid adipose tissue in front of and around the right iliac and external iliac arteries was removed bluntly and sharply from top to bottom. The lymphatic adipose tissue in front of the external iliac vein was further dissociated and pulled outward to expose the internal iliac artery and separate the lymphatic adipose tissue. The deep inguinal lymph nodes were separated at the lowest end of the iliac vessels, and the distal end reached the intersection of the iliac circumflex veins.

Step 3: pull the bladder to the inside, pull the external iliac vein open, enter the obturator fossa, and separate the obturator nerve. Above the obturator nerve, the obturator fossa lymphatic adipose tissue was separated from bottom to top. At this point, pelvic iliac vessels, inguinal and obturator lymph nodes were cleared. The left pelvic lymph nodes were dissected and the internal iliac artery was ligated to reduce the bleeding during hysterectomy. During the operation, we should pay special attention to the details, and each link is particularly critical.

matters needing attention

After pelvic lymphadenectomy, we should pay attention to the maintenance in the later stage, and have reasonable living habits in peacetime. We should pay attention to the recovery of the body in daily diet.