腔镜下腹股沟淋巴结切除术中对前哨淋巴结的辨认和处理

目的 探讨腔镜下腹股沟淋巴结切除术中对前哨淋巴结的辨认和处理,并寻找外阴癌淋巴引流的主要途径。方法 收集3例外阴鳞癌患者,在腔镜下腹股沟淋巴结切除术前,于肿瘤的外上方皮内和皮下注射亚甲蓝注射液,在腔镜下切除腹股沟淋巴结的过程中寻找蓝染的淋巴结和淋巴管,并确定其所在的位置。结果 3例外阴癌患者均显示出蓝染的前哨淋巴结和淋巴管,并予以切除。前哨淋巴结均为位于腹壁浅静脉上内方的耻骨结节旁淋巴结。结论 腹股沟前哨淋巴结在腔镜下腹股沟淋巴结切除术中容易辨认和切除,耻骨结节旁淋巴结是外阴癌重要的前哨淋巴结。     

腹腔镜下腹股沟淋巴结切除术治疗外阴癌的临床研究

目的　探讨外阴浸润癌行腹腔镜下腹股沟淋巴结切除术的可行性和手术技巧。方法　２０１０年１１月至２０１１年８月对１０例外阴癌患者行根治性局部外阴切除术和腹腔镜下腹股沟淋巴结切除术,必要时行盆腔淋巴结切除术。结果　１０例患者均在腹腔镜下腹股沟淋巴结切除术后行根治性局部外阴切除。平均每侧腹股沟淋巴结切除手术时间为９１ｍｉｎ（８０～１３０ｍｉｎ）,术中每侧腹股沟淋巴结切除平均出血为６.３ｍｌ（５～１０ｍｌ）,切除淋巴结数平均为７.４个（单侧）,淋巴结转移２例,平均拔管时间为６.８ｄ（５～１０ｄ）,所有患者均未发生腹股沟区皮肤坏死。结论　外阴广泛切除联合腹腔镜下腹股沟淋巴结切除术治疗外阴浸润癌安全、可靠,手术创伤小,术后切口愈合佳,不易发生腹股沟区皮肤缺血坏死。     

外阴癌腹腔镜下腹股沟淋巴结清扫术的临床研究

目的：探讨外阴浸润癌行腹腔镜下腹股沟淋巴结切除术的可行性和手术技巧。方法回顾性分析40例外阴癌患者。其中腹腔镜组行腹腔镜下双侧腹股沟淋巴结清扫术,共20例;开放组行开放性双侧腹股沟淋巴结清扫术,共20例。两组患者均同时行根治性局部外阴切除术。结果所有患者均顺利完成手术,腹腔镜组的手术时间为（311．80±17．71）分钟,长于开放组的（206．90±12．95）分钟（P＜0．01）。腹腔镜组淋巴结切除时间长于开放组,分别为（181．00±11．04）分钟和（91．50±5．47）分钟（P＜0．01）。淋巴结清扫出血量腹腔镜组少于开放组,分别为（16．25±2．26）mL和（66．75±10．23）mL,但差异无统计学意义（P＝0．104）。术中总出血量、左右侧腹股沟淋巴结切除数目两组比较差异均无统计学意义（均 P＞0．05）。术后住院天数腹腔镜组短于开放组,分别为（15．15±1．04）天和（21．50±2．61）天,而腹股沟区手术相关并发症及淋巴相关并发症腹腔镜组均少于开放组（均P＜0.01）。术后观察随访0.5－5年,两组间局部复发率、远处转移率、病死率等差异均无统计学意义（均 P＞0.05）。结论外阴癌腹腔镜下腹股沟淋巴结清扫术是安全、可行的,能明显减少术后并发症,缩短住院时间,并不增加术后复发的风险。     

不同手术方式联合术后放疗对外阴鳞癌预后的影响

目的对比不同手术方式联合术后放疗对外阴鳞癌的疗效,寻找理想的治疗方法。方法对1980年1月～2005年12月在中山大学肿瘤防治中心经手术治疗并确诊的150例外阴鳞癌进行回顾性分析,生存率计算采用寿命表法,预后比较采用Kaplan-Meier法。多因素预后分析采用Cox回归分析。结果对淋巴结阳性的患者,行外阴广泛切除＋腹股沟淋巴结清扫和（或）盆腔淋巴结清扫术＋放疗、外阴广泛切除＋腹股沟肿大淋巴结切除术＋放疗、外阴广泛切除术＋放疗、外阴广泛切除＋腹股沟淋巴结清扫和（或）盆腔淋巴结清扫术,5年生存率分别为29%、25%、17%、67%（P=0.031）,5年无进展生存率分别为100%、50%、67%、83%（P=0.016）,行外阴广泛切除＋腹股沟淋巴结清扫和（或）盆腔淋巴结清扫术＋放疗者,预后明显好于其余治疗方式患者。对术前检查未发现明显淋巴结肿大的患者,行外阴广泛切除＋腹股沟淋巴结清扫和（或）盆腔淋巴结清扫术,5年生存率（84%vs.46%,P=0.010）和无进展生存率（97%vs.62%,P〈0.001）均明显高于外阴广泛切除术＋放疗患者。结论对中晚期患者,应争取切除原发灶及行腹股沟淋巴结清扫,并术后辅以全量放疗,而对早期外阴癌患者,建议在切除外阴病灶的同时行腹股沟淋巴结清扫术。     

阴茎切除联合改良腹股沟淋巴结清扫术治疗阴茎癌的疗效观察

目的探讨阴茎切除联合改良腹股沟淋巴结清扫术治疗阴茎癌的临床疗效。方法广东梅州市人民医院2015年1月至2017年8月收治并确诊为阴茎癌患者9例,2例采用阴茎全切除术,7例采用阴茎部分切除联合改良腹股沟淋巴结清扫术,治疗结束后分析手术情况,并对住院时间及术后并发症情况进行统计。结果 9例患者手术时间(327.78±65.83)min,术中出血量(71.11±15.31)ml,住院时间(18.36±1.25)d;术后并发症包括皮瓣坏死需植皮1例,切口感染1例,皮下积液1例及下肢淋巴水肿2例。结论治疗阴茎癌采用阴茎全切除术或部分切除术联合改良腹股沟淋巴结清扫术可取得较好的手术效果,并能控制术后并发症,改善预后。     

外阴恶性肿瘤腹股沟淋巴结清扫术后腹股沟区创面处理的临床观察

目的 探讨外阴恶性肿瘤腹股沟淋巴结清扫术手术切口的改良缝合法及腹腔镜下腹股沟淋巴结清扫术的可行性。方法 回顾性分析外阴恶性肿瘤腹股沟淋巴结清扫术手术切口的改良缝合法（改良组）与传统缝合法（传统组）及腔镜下腹股沟淋巴结清扫术（腔镜组）的腹股沟切口的平均愈合时间、Ⅰ期愈合率及延迟愈合率。结果 传统缝合法的16例患者平均愈合时间为（28.0±19.2）天,其中6例为Ⅰ期愈合;改良缝合法的9例患者平均愈合时间为（14.2±6.2）天,其中8例为Ⅰ期愈合;16例腔镜法手术的腹股沟创面的Ⅰ期愈合率为93.8％（其中1例合并糖尿病者延期愈合）。传统组的平均愈合时间显著长于改良组（P＜0.05）。3组延迟愈合率分别为62.5％、11.1％和6.2％,传统组显著高于改良组和腔镜组（P＜0.05）,腔镜组与改良组相比差异无统计学意义（P＞0.05）。 结论 外阴恶性肿瘤腹股沟淋巴结清扫术后腹股沟区皮肤切口的改良缝合法和腔镜下腹股沟淋巴结清扫术后的腹股沟皮肤的愈合情况均显著优于传统缝合方法,值得临床推广和应用。     

妇科恶性肿瘤淋巴结切除术后下肢淋巴水肿的相关因素分析

目的 探讨妇科恶性肿瘤淋巴结切除术后下肢淋巴水肿的相关危险因素,以此指导临床对术后下肢淋巴水肿的预防和治疗.方法 回顾性分析2012年1月至2018年5月1489例确诊为妇科恶性肿瘤并行盆腔淋巴结清扫或切除、伴/不伴腹主动脉旁淋巴结切除或腹股沟淋巴结切除术的患者的临床病理资料,对术后下肢淋巴水肿的发生情况进行总结并分析...     

全腔镜乳房皮下腺体切除术：附96例报告

目的 探讨全腔镜乳房皮下腺体切除的手术方法及治疗效果。方法 对2004年8月至2007年10月间共96例男性乳房发育患者和女性乳腺癌患者行全腔镜乳房皮下腺体切除手术。腔镜手术前对乳房皮下和乳房后间隙充分溶脂和吸脂，通过充气法建立操作空间，腔镜下只需切断乳房皮下和腺体间相连的纤维条索及乳房边缘腺体和周围筋膜附着处即可顺利完成腺体切除。并对乳腺癌患者行后续前哨淋巴结活检、腋窝淋巴结清扫及假体植入乳房重建手术，术后行常规辅助治疗。全部患者随访3个月至3年，观察手术安全性及美容效果。结果 96例共156侧乳房均顺利完成全腔镜皮下腺体切除；单纯腔镜皮下腺体切除的时间为35～125min，平均71min；术中出血量30～170ml，平均94ml。术后并发症发生率2．6％（4／156），其中单侧乳头部分坏死3例，局部皮下积液1例。术后美容效果良好，患者满意率97．9％（94／96）。随访3个月至3年均未出现疾病复发或转移。结论 全腔镜乳房皮下腺体切除手术并发症少，安全性高，美容效果好。     

外阴癌临床治疗309例报告

目的　分析外阴癌不同治疗方法的结果 ,并探讨其复发转移的特征。方法　采用回顾性研究的方法 ,对 30 9例外阴癌的临床治疗结果进行分析。结果　 30 9例患者总的 5年生存率为6 7.9% ,Ⅰ、Ⅱ、Ⅲ及Ⅳ期的 5年生存率分别为 86 .9%、82 .5 %、5 9.2 %和 43.6 %。总的治疗失败率为49 .8% (其中 2年内失败者占 6 9.5 % ) ;复发部位依复发时间不同而异 ,83.6 %的腹股沟、盆腔及远处转移发生在治疗后 2年内 ,外阴局部复发占 2年后治疗失败的 81.1%。外阴癌复发转移与年龄无关。Ⅰ期癌各种治疗方法的生存率及治疗失败率差异无显著性。Ⅱ期癌外阴根治性切除 腹股沟清扫术生存率较高 (P <0 .0 5 ) ;腹股沟淋巴结阳性者 ,手术治疗的失败率显著低于放疗 (P <0 .0 5 ) ;腹股沟淋巴结阴性者 ,两种治疗方式差异无显著性 ;腹股沟预防照射剂量Dm达 6 0Gy者 ,失败率显著低于剂量Dm <6 0Gy者 (P <0 .0 5 )。结论　早期外阴癌应施行外阴根治性切除 ,加施预防性淋巴清扫或腹股沟足量放疗 ;对中晚期患者 ,争取切除原发灶及行腹股沟淋巴清扫 ,并辅以术前、术后放疗。     

保留大隐静脉的腹股沟淋巴清扫术对外阴癌手术治疗价值的探讨

传统的腹股沟淋巴清扫术方法是需将股三角内的大隐静脉段高位结扎切除,外阴癌患者经腹股沟清扫术后公认因淋巴回流障碍而致下肢不同程度水肿和创口延迟愈合,我们根据静脉可帮助淋巴液回流的原理,设计了保留大隐静脉的腹股沟淋巴清扫术式,自1991年10月至1992年11月共施行8例,总结探讨其应用的价值.     

Clinical study about endoscopic inguinal lymphadenectomy for patients with vulvar carcinoma

Objective

The aim of this study was to explore the new method of inguinal lymphadenectomy in order to reduce side effects of conventional method for patients with vulvar carcinoma.

Methods

Lipolysis and liposuction were performed to subcutaneous fat on inguinal region. We inserted endoscope and filled with CO₂ gases to this field and then resected inguinal lymph nodes with ultrasonic scalpel. The operative field was placed with the vacuum sealing drainage and pressured with soft saline bag after the operation.

Results

Many lymphatic vessel, small blood vessels and hanging lymph nodes in the subcutaneous tissues of inguinal region were revealed after lipolysis and liposuction and lymph nodes can be easily removed. The follow-up so far showed that healing of the incision was good and there was no lymphedema of patient’s lower limb and inguinal region.

Conclusion

Endoscopic inguinal lymphadenectomy can resect the lymph nodes and keep most of the lymphatic vessels. So this technique has less influence on the lymph backflow of lower limb and inguinal region and can avoid the huge incision of conventional method. This method is worthy of further study.     

Clinical Application of Endoscopic Inguinal Lymph Node Resection after Lipolysis and Liposuction for Vulvar Cancer

Aim: To examine lymph nodes obtained after lipolysis and liposuction of subcutaneous fat of the inguinalregion of female vulvar cancer patients to explore the feasibility of clinical application. Methods: The field ofoperation was on the basis of the range of the conventional resection of inguinal lymph nodes. We injected lipolysisliquid fanwise, started liposuction after 15-20 minutes; then the subcutaneous fatty tissue was sucked out clearlyby suction tube. We selected the first puncture holes located on 2-3 cm part below anterior superior spine, theothers respectively being located 3cm and 6cm below the first for puncturing into the skin, imbedding a trocarto intorduce CO₂ gas and the specular body, and excise the lymph nodes by ultrasonic scalpel. The surgicalfield chamber was set with negative pressure drainage and was pressured with a soft saline bag after surgery.Results: A lacuna emerged from subcutaneous of the inguinal region after lipolysis and liposuction, with a widefascia easily exposed at the bottom where lymph nodes could be readily excised. The number of lymph nodesof ten patients excised within the inguinal region on each side was 4-18. The excised average number of lymphnodes was 11 when we had mature technology. Conclusion: Most of adipose tissue was removed after lipolysisand liposuction of subcutaneous tissue of inguinal region, so that the included lymph nodes were exposed andeasy to excise by endoscope. This surgery avoided the large incision of regular surgery of inguinal region, theresults indicating that this approach is feasible and safe for used as an alternative technology.     

Carcinoma of the penis

Most premalignant penile lesions should be completely locally excised. Giant condyloma frequently cannot be distinguished from fungating carcinoma and usually requires limited penectomy. Cancers other than epidermoid carcinomas are very rare and, except for basal cell carcinoma, have a generally poor prognosis. Prognosis of squamous cell carcinoma, however, depends on the stage of disease as determined by both local invasion and by involvement of inguinal nodes. The three-year survival rates for 55 patients were: stage I, 95 percent; stage II, 67 percent; stage III, 29 percent; and stage IV, zero percent. Most primary lesions were treated by partial penectomy, and no patient developed local recurrence. There is a significant discrepancy between initial clinical and histologic staging, due to the difficulty of determining lymph node metastases. Current methods of radiation therapy indicate that it has a role for management of primary penile cancer, especially in young men with small lesions. The management of inguinal lymph nodes is still debated. Although the reliability of the sentinel node biopsy has not been established, it may be appropriate in patients with noninvasive primary lesions and no detectable inguinal metastases. The need for immediate or prophylactic lymph node dissection in patients with invasive primary tumors is controversial. Successful management depends on careful and frequent follow-up examinations, with early intervention for suspicious adenopathy. In view of the poor prognosis for advanced lymph node metastases, we prefer to use early lymph node dissection when the primary lesion is deeply invasive. Limited bilateral pelvic lymph node dissection is associated with minimal morbidity and seems to be an appropriate prelude to groin dissection. Extensive pelvic metastases are a sign of incurability and abrogate the need for groin dissection. We prefer to perform the inguinal dissection at the time of lymph node dissection through a separate curve groin incision.     

Feasibility and morbidity of sentinel lymph node detection in patients with vulvar carcinoma

The aim of this study was to investigate the feasibility and the morbidity of sentinel lymph node detection in patients with vulvar carcinoma. In 15 patients with vulvar squamous cell carcinoma, the inguinal sentinel lymph nodes was detected using both peritumoral injection of technetium-99m sulfur colloid and isosuflan blue before the surgical time. The detection of the inguinal sentinel lymph node was never completed by an inguinal lymphadenectomy. In case of metastatic lymph node, patients were treated by complementary inguinal irradiation. A total of 19 inguinal node dissection were performed. The sentinel lymph node was identified in 18/19 (94.7%) groin dissections. A total of 38 sentinel lymph nodes were removed. 4 patients were found to have metastatic lymph node (26.7%) with a total of 6 metastatic lymph nodes. The postoperative morbidity was minimal, with only one patient presenting a permanent edema of the extremity (6.7%) after complementary inguinal irradiation. We confirm the results of previous studies that sentinel node dissection appears to be technically feasible in patients with vulvar carcinoma. This may reduce the morbidity of usual inguinal lymphadenectomy without under-evaluate the nodal status. This procedure could be implemented in future therapy concepts.     

Ras-p21, p53在阴茎癌腹股沟淋巴结中的表达及临床意义

目的探讨阴茎癌腹股沟淋巴结ras-p21, p53基因蛋白的表达及临床意义。方法 取收治的阴茎癌44例, 随机切取腹股沟淋巴结44枚, 病理证实为转移癌的18枚, 炎性26枚;另选取同期腹股沟感染淋巴结20枚, 正常淋巴结20枚。石蜡切片, S-P染色。检测ras-p21, p53基因蛋白的表达。结果 ras-p21, p53的表达在阴茎癌腹股沟淋巴结组与对照组(正常淋巴结组、非瘤炎性淋巴结组)相比显著增高(P＜0.05)。腹股沟淋巴结癌转移阳性组较阴性组ras-p21, p53的表达显著增高(P＜0.05)。结论 在淋巴结病理检查的同时行p21蛋白和p53蛋白检测可提高阴茎癌转移诊断率。ras-p21蛋白和p53基因蛋白检测可以作为肿瘤是否转移和预后效果判定的客观指标。可做为阴茎癌是否行腹股沟淋巴结清除手术的判断指标。     

A case of advanced transvers colon cancer with inguinal lymph node metastasis

An 80-year-old woman complaining of a right inguinal induration and pain was performed an inguinal lymph node resection. Histological examination with immnohistochemistry revealed that the lymph node was metastasis of colon carcinoma. With total colonoscopy, she was diagnosed as advanced transvers colon cancer with right inguinal lymph node metastasis. She was performed a right hemi-colectomy. She was dead with peritoneal metastasis of colon cancer 2 years and 1 month later. We report this case that was diagnosed having transverse colon cancer with inguinal lymph node metastasis.     

Inguinal lymph node recurrence of mucosal cancer of the stomach

Metastasis to the inguinal lymph node from early gastric cancer is rare. We report a case of 63-year-old Japanese male with gastric mucosal cancer which metastasized to the left inguinal lymph nodes 4 years after a curative gastrectomy. The importance of routine examination of inguinal lymph nodes for cases with gastric cancer is suggested.     

The sentinel node in anal carcinoma

AIMS AND BACKGROUND: Anal cancer is a rare condition. The inguinal lymph nodes are the most common site of metastasis in this neoplasm. The inguinal lymph node status is an important prognostic indicator and the presence of metastases is an independent prognostic factor for local failure and overall mortality. Depending on the primary tumor size and histological differentiation, metastasis to superficial inguinal lymph nodes occurs in 15-25% of cases. METHODS AND STUDY DESIGN: To evaluate the inguinal lymph node status we performed a search for the sentinel node in a female patient affected by squamous and carcinoma. RESULTS: Identification and examination of the sentinel node was positive and postoperative histology showed the presence of bilateral lymph node metastases. CONCLUSIONS: We suggest that examination of the sentinel node in anal cancer could be an efficient way to establish the inguinal lymph node status, which would help the clinician to plan and perform adequate treatment.     

Inguinal or inguino-iliac/obturator lymph node dissection after positive inguinal sentinel lymph node in patients with cutaneous melanoma

Background

The aim of the study was to determine whether the presence of inguinal sentinel lymph node (SLN) metastases smaller than 2 mm (micrometastases) subdivided according to the number of micrometastases predicts additional, non-sentinel inguinal, iliac or obturator lymph node involvement in completion lymph node dissection (CLND).

Patients and methods.

Positive inguinal SLN was detected in 58 patients (32 female, 26 male, median age 55 years) from 743 consecutive and prospectively enrolled patients with primary cutaneous melanoma stage I and II who were treated with SLN biopsy between 2001 and 2007.

Results

Micrometastases in inguinal SLN were detected in 32 patients, 14 were single, 2 were double, and 16 were multiple. Twenty-six patients had macrometastases.

Conclusions

No patient with any micrometastases or a single SLN macrometastasis in the inguinal region had any iliac/obturator non-sentinel metastases after CLND in our series. Furthermore, no patient with single SLN micrometastasis in the inguinal region had any non-sentinel metastases at all after CLND in our series. In these cases respective CLND might be omitted.