腹腔镜腹股沟淋巴结清扫术治疗阴茎癌及生殖肿瘤的初步临床体会

目的:总结腹腔镜腹股沟淋巴结清扫术术后并发症及控瘤效果。方法:回顾分析为10例男性患者(14侧)行腹腔镜腹股沟淋巴结清扫术的临床资料。股三角尖部下约3 cm处做10 mm观察孔,另两个切口分别位于距第一切口约6 cm的股三角外侧及内侧(10 mm、5 mm)。分离皮瓣后,以大隐静脉为解剖标志,清扫浅组及深组淋巴脂肪组织,手术清扫范围同开放根治术。记录手术清扫的淋巴结,分析并发症发生原因。结果:手术时间每侧平均(130±24.9)min,每侧平均清扫淋巴结(12.1±1.2)枚,每天每侧引流量平均(60.3±37.3)ml。3例患者发生轻微并发症,1例术中出现高碳酸血症及皮下气肿,1例术后发生50 ml的血清肿,1例手术部位出现180 ml的淋巴液肿。平均随访(24±11.7)个月,无肿瘤复发及其他并发症发生。结论:腹腔镜腹股沟淋巴结清扫术治疗转移性阴茎癌及恶性生殖肿瘤是可行的,不仅可明显减少术后并发症,而且控瘤效果令人满意。但应进行大宗病例的研究,并长期随访以评价其控瘤效果及潜在并发症。

Laparoscopic radical inguinal lymphadenectomy in the treatment of penile cancer and genital tumor

Objective:To explore the postoperative complications and results of tumor control of laparoscopic inguinal lymphadenectomy.Methods:Fourteen inguinal lymph nodes resection were performed in ten patients(14 sides) via laparoscopy.Three Trocars were used during the procedure.The first of 10 mm was placed 3 mm distal to the apex of the femoral triangle as observation port,and two others of 10 mm and 5 mm were positioned 6 cm medially and laterally to the femoral triangle respectively.After separation of flap,great saphenous vein was used as anatomic landmark,the superficial and deep lymph nodes were dissected step by step.The boundaries of dissection were the same as those of open radical inguinal lymphadenectomy.The numbers of harvested lymph nodes were recorded,and the reasons of complications were retrospectively analyzed.Results:The average operation time was(130±24.9) min for each side.The mean number of unilateral lymph nodes was(12.1±1.2).The average output of drainage per leg was(60.3±37.3) ml/d.3 patients got minor complications.One had hypercarbia and subcutaneous emphysema,and another had 50 ml of seroma,the third,180 ml of lymphocele.Follow-up time was(24±11.7) months,there was no case of recurrence or other complications.Conclusions:Laparoscopic inguinal lymphadenectomy is feasible in the treatment of metastatic penile cancer and genital malignant tumor.This procedure can not only reduce postoperative complications,but also get satisfying results of tumor control.Study with large amount of cases and long-term follow-up should be performed in order to evaluate its results of tumor control and potential complications.