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  • Role of Minimally Invasive Surgery in Ovarian Cancer Farr R. Nezhat, MD*, Tanja Pejovic, MD, Tamara N. Finger, MD, and Susan S. Khalil, MD


"Pelvic lymphadenectomy dissection began at the origin of the external iliac vessels and continued
caudally along the medial border of the psoas muscle, with the
lower limit of the external iliac lymphadenectomy being represented
by the deep inferior epigastric vessels. The lateral boundaries
of the lymphadenectomy were delineated superfi cially by the
fascia covering the psoas muscle and deeply by the fascia covering
the internal obturator and levator ani muscles. The medial margin
of the lymphadenectomy was represented by an imaginary plane
parallel to the umbilical artery, the umbilico-pubic fascia, the bladder,
and the rectum. The clearing of the obturator fossa began with
mobilization of the superfi cial obturator nodes, which were removed
en bloc (i.e., all together) with the lymphatic fatty tissue
that had been previously separated from the internal iliac vessels to
the origin of the internal pudendal vessels. Lymphadenectomy
continued with the dissection of the deep obturator nodes and gluteal
nodes.
Pelvic lymphadenectomy was considered appropriate when at least 25 nodes were removed.

Aortic lymphadenectomy dissection began at the aortic bifurcation by removing the superfi cial intercavoaortic, precaval, and preaortic nodal groups. Lymph nodes located lateral to the vena cava (i.e., paracaval nodal group) were separated from the vena cava, and the renal capsule and psoas muscle were removed en bloc. Lymph nodes behind the vena cava (i.e., retrocaval nodal group) and the lumbar vessels (i.e., deep intercavo-aortic nodal group) were separated and removed from the prevertebral fascia after displacing the vena cava and the aorta laterally and medially. Removal of the cranial nodes, both behind and under the left renal vein, was performed after entering the plane between the Toldt's and Gerota's fasciae; mobilizing the descending colon from the renal capsule, the psoas muscle, and the ovarian pedicle; and displacing the ureter laterally. Aortic lymphadenectomy was considered appropriate when at least 15 nodes were removed. " Journal of the National Cancer Institute, Vol. 97, No. 8, April 20, 2005
Managing Incidental Findings on Abdominal and Pelvic CT
and MRI, Part 1: White Paper of the ACR Incidental Findings
Committee II on Adnexal Findings

 

Data ostatniej aktualizacji: 2019-06-17