腹腔镜与开放性腹股沟淋巴结清扫术的临床比较及分析

目的:探讨腹腔镜与开放性规范化腹股沟淋巴结清扫术的临床疗效及并发症。方法:回顾性分析2010年10月~2014年1月施行的26例淋巴结清扫手术患者的临床资料:以淋巴结清扫手术方式的不同分为腹腔镜组和开放性组,统计分析两组患者年龄、病程、原发灶病理分级等一般资料,进而比较两组术中出血量、手术时间、术后恢复时间、术后并发症发生率及手术效果有无差异。结果:腹腔镜组术中出血量(29.2±15.3)ml,开放性组术中出血量(81.6±42.5)ml,差异有统计学意义(P0.05);腹腔镜组术后住院时间(15.8±5.5)d,开放性组术后住院时间(24.3±10.8)d,差异有统计学意义(P0.05);腹腔镜组无皮瓣坏死及切口感染发生(0/12),开放性组皮瓣坏死及切口感染发生5例(5/14),差异有统计学意义(P0.05)。而腹腔镜组手术时间(168.5±41.8)min,开放性组手术时间(156.6±33.1)min,差异无统计学意义(P0.05),腹腔镜组术后淋巴漏囊肿发生2例(2/12),开放性组术后无淋巴漏囊肿发生(0/14),差异无统计学意义(P0.05);术后随访4个月~3年,腹腔镜组1例复发,开放性组2例复发,均无死亡患者,差异无统计学意义(P0.05)。结论:腹腔镜腹股沟淋巴结清扫术与传统开放手术相比,不仅可以获得相同的临床疗效,而且具有创伤小、术后恢复快、皮瓣坏死率低、住院时间短的优势,是值得推广的一种淋巴结清扫术式。

Clinical comparison and analysis of laparoscopic surgery and open surgery of inguinal lymphadenectomy

Objective：To evaluate the clinical efficacy and complications of laparoscopic surgery and open surgery of inguinal lymphadenectomy in patients with penis carcinoma.Method：From October 2010 to January 2014,26 consecutive subjects were enrolled in the study.The retrospective analysis of clinical data of 12 patients who had laparoscopic inguinal lymphadenectomy and 14 patients who had open inguinal lymphadenectomy were collected.The age of patients,duration of disease,tumor stage and other general information were compared between two groups.Then the intraoperative blood loss,operative time,postoperative recovery time,incidence of postoperative complications and results of operations were also compared between two groups in order to find significant differences.Result：The mean blood loss of laparoscopic surgery group and open surgery group were（29.2±15.3）ml,（81.6±42.5）ml respectively.The mean postoperative hospital stay of laparoscopic surgery group and open surgery group were（15.8±5.5）days,（24.3±10.8）days respectively.Laparoscopic group had no skin flap necrosis and wound infection,but five cases of open group were found skin flap necrosis and wound infection.There were significant differences between the two groups（P〈0.05）.However,the mean operative time of laparoscopic surgery group and open surgery group were（168.5±41.8）min,（156.6±33.1）min respectively,and the difference was not statistically significant.The incidence of lymphatic fistula showed no statistically different between the two groups（P〉0.05）.Over the follow-up period of four months to three yesrs,one case of laparoscopic surgery group and two cases of open surgery group recurred.Conclusion：Compared with the open inguinal lymphadenectomy,laparoscopic inguinal lymphadenectomy not only can achieve the same clinical efficacy but also leads to less trauma,quicker postoperative recovery,lower incidence of skin flap necrosis and shorter hospital stay.So laparoscopic surgery is worth promoting in inguinal lymp