ABSTRACT
OBJECTIVE: To evaluate the clinical significance of laparoscopic extraperitoneal para-aortic lmphadenectomy(PAL)in high para-aortic lymphadenectomy.METHODS: A non-randomized controlled method was used to analyze the clinical data of laparoscopic extraperitoneal PAL in 35 patients(extraperitoneal group)and laparoscopic transabdominal PAL in 40 patients(transabdominal group)in the Gynecological Department of the First Affiliated Hospital of Xiamen University from March 2018 to April 2019.RESULTS: All the 35 cases of laparoscopic extraperitoneal PAL reached the level of renal vein.Endometrial cancer accounted for the largest proportion,with an average age of 47.57 years and an average body mass index of 23.77.The average operation time was 109 minutes in the first 6 cases and 74.73 minutes in the other 29 cases.The amount of hemorrhage was 15.19 mL,and the average number of para-aortic lymph nodes(PALN)resected was 17.87.There were 5 cases of positive PALN metastasis,and the average gastrointestinal recovery time was13.43 hours.The average postoperative pelvic drainage was 76.57 hours and the average postoperative hospital stay was8.24 days.Intraoperative and postoperative complications included 1 case of inferior vena cava rupture,1 case of chyle leakage,and 1 case of vulvar edema.None of the 40 cases of laparoscopic transabdominal PAL reached the level of renal vein,and endometrial cancer accounted for the largest proportion,with the average age of 46.78 years and the average body mass index of 24.03.The average operation time was 90.55 min;the average intraoperative blood loss was 67.40 mL The average number of para-aortic lymph nodes was 3.30.There was one case of PALN metastasis.The average gastrointestinal recovery time was 22.35 hours,and the average postoperative pelvic drainage time was 75.75 hours.The average length of hospital stay was 8.90 days.There were 2 cases of rupture of the inferior mesenteric artery,3 cases of chyle leakage,and 2 cases of vulvar edema.The number of PALN resection,intraoperative blood loss,and operation time in the extraperitoneal group were not related to the body mass index,but the number of PALN in obese patients in the laparoscopic transabdominal group was significantly reduced,the operation time was longer,the intraoperative blood loss was more,and postoperative gastrointestinal recovery time is longer(P<0.05).CONCLUSION: Laparoscopic extraperitoneal PAL can solve the problems of laparoscopic transabdominal PAL lymph node resection,which is difficult to reach the level of renal vein,intraoperative intestinal tube interference,and the number of lymph nodes resected.It is especially suitable for obese patients.Laparoscopic extra-peritoneal high-grade PAL is safe,feasible,and recommended.
ABSTRACT
Objective Previous studies found that characteristic sulfur-containing derivatives induced by sulfur-fumigation of medicinal herbs could be used together with sulfur dioxide (SO2) as chemical markers for the quality control of sulfur-fumigated herbs owing to the more specific and reproducibility of characteristic sulfur-containing derivatives over SO2 index. In this paper, the feasibility of these two indices used for the quality control of herbal dispensing granules was further investigated. Methods Using Paeoniae Radix Alba (PRA) as an example, the contents of SO2, paeoniflorin as well as paeoniflorin sulfonate, the characteristic sulfur-containing derivatives of sulfur-fumigated RPA in PRA processing pieces, decoctions, concentrates, and dried extracts were quantified by SO2 residue determination method documented in Chinese Pharmacopeia and HPLC technique, and the transfer ratios of these components during preparation procedures of PRA dispensing granules were evaluated. Results It was found that SO2, paeoniflorin and paeoniflorin sulfonate could all be detectable in the samples of decoctions, concentrates and dried extracts, indicating that these three components could be used as chemical markers to indicate the quality changes during preparation of PRA dispensing granules. However, the transfer ratios of these three components were different from each other, with the contents of SO2 and paeoniflorin decreased, whereas that of paeoniflorin sulfonate increased during preparation of PRA dispensing granules. In addition, in those commercial PRA dispensing granules samples SO2 detectable, paeoniflorin sulfonate also detectable. Conclusion Since SO2 residue is a safety index, while paeoniflorin and paeoniflorin sulfonate can reflect the inner quality and the impact extent of sulfur-fumigation on the quality of PRA dispensing granules respectively, the three components might be used together as chemical markers for the quality control, and consequently to ensure the safety and efficacy of PRA dispensing granules.