外阴恶性肿瘤腹股沟淋巴结清扫术中保留大隐静脉在降低术后并发症中的价值

目的：探讨外阴恶性肿瘤腹股沟淋巴结清扫术中保留大隐静脉主干对降低术后并发症的作用。方法：将1989年1月-2005年12月期间住院并行双侧腹股沟淋巴结清扫术的64例外阴恶性肿瘤患者分为两组，31例行双侧腹股沟淋巴结清扫术时保留双侧大隐静脉主干，33例结扎、切除一段大隐静脉，对两组患者的术后急慢性并发症进行比较。结果：两组患者的手术时间、术中出血量均无显著差别，切口愈合时间、感染率相似，但下肢急慢性水肿、下肢疼痛、下肢软组织炎症发生率、感觉异常等并发症在保留大隐静脉组较切除组均明显降低。结论：外阴恶性肿瘤行腹股沟淋巴结清扫术时保留双侧大隐静脉主干不延长手术时间，不增加手术难度，但能明显降低多种术后并发症的发生率，提高了患者的生活质量。     

外阴恶性肿瘤保留大隐静脉的腹股沟淋巴结清扫术改良术式的探讨

背景与目的:外阴恶性肿瘤传统手术方式为外阴广泛切除术 双侧腹股沟淋巴结清扫术伴大隐静脉的结扎和切除,术后多种并发症的发生严重影响了患者的生存质量.本研究探讨外阴恶性肿瘤行腹股沟淋巴结清扫术保留大隐静脉对手术操作、预后及并发症的影响.方法:将1989年1月至2005年12月期间收住院并行双侧腹股沟淋巴结清扫术的64例外阴恶性肿瘤患者分为两组,31例行双侧腹股沟淋巴结清扫术时保留双侧大隐静脉主干(简称保留组),33例结扎、切除一段大隐静脉(简称切除组),对两组患者的手术时间、术中出血量、5年生存率、复发率及术后急慢性并发症进行比较.结果:(1)保留组中,双侧腹股沟淋巴结清扫术手术时间为130～170 min,中位时间155 min:出血量100～450 ml,中位出血量295 ml.切除组中,手术时间为120～170 min,中位时间140 min;出血量150～390 ml,中位出血量270 ml.两组比较,两个参数差异均无显著性,P值均＞0.05;(2)两组患者总的5年生存率为67.3%,切除组为66.7%,保留组为68.0%,两组比较差异无显著性,P＞0.05.随访至2006年3月,保留组共发现3例5侧腹股沟淋巴结复发,切除组5例7侧复发,复发率分别为8.9%(5/56)、12.1%(7/58),两者比较差异无显著性,P＞0.05;(3)保留组急性下肢静脉炎,急性下肢淋巴水肿的发生率分别为11.3%,43.5%;切除组分别为25.8%,66.7%,两组比较差异有显著性(P值分别＜0.05,＜0.01).保留组迟发性下肢水肿和下肢疼痛的发生率分别为25.0%,23.2%,切除组48.3%,46.6%,两组比较差异均具有非常显著性(P值均＜0.01);两组下肢蜂窝组织炎及感觉异常的发生率差异亦具有显著性(P值均＜0.05).结论:外阴恶性肿瘤行腹股沟淋巴结清扫术时保留双侧大隐静脉主干不延长手术时间,不增加手术难度,不降低患者长期生存率,但能明显降低术后并发症的发生率,提高患者的生活质量,是值得推广的手术方式.     

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。     

保留大隐静脉的外阴癌根治术

目的评价大隐静脉保留对外阴癌根治术的影响。方法在11例外阴癌根治术中保留大隐静脉及其属支，并与8例传统手术组进行比较。结果两组手术时间和出血量大致相似，而保留大隐静脉组术后下肢水肿减少（27．00％vs50．00％），切口Ⅰ期愈合增加（45．45％vs12．50％），切口换药次数减少（11次vs19次），随访未发现腹股沟区淋巴结复发。结论保留大隐静脉有利于减少外阴癌术后并发症的发生，而不改变治疗效果，外阴癌根治术中应常规保留大隐静脉及其属支。     

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.     

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。     

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。     

治疗方式对外阴鳞癌ⅠB期复发的影响

摘 要：［目的］ 探讨外阴鳞癌ⅠB期不同治疗方式的复发情况。［方法］ 对30例确诊并治疗的外阴鳞癌ⅠB期进行回顾性分析,用Kaplan-Meier方法进行预后比较。［结果］ 外阴鳞癌ⅠB期1年复发率为26.67％（8/30）。对于仅行手术治疗者,外阴局部扩大切除术患者复发率为60％（3/5）,而外阴广泛切除术+腹股沟淋巴结清扫者为23.0％（3/13）,差异具有统计学意义（P=0.045）。对于行外阴广泛切除术+腹股沟淋巴结清扫术者23例,有复发高危因素如病理分化差、瘤体大等共14例,行外阴广泛切除术+腹股沟淋巴结清扫术+放疗和(或)化疗者1年复发率为10％（1/10）,而行外阴广泛切除术+腹股沟淋巴结清扫术者为50%（2/4）,1年复发率差异具有统计学意义（P=0.03）。［结论］ 对于ⅠB期外阴鳞癌,尽可能行腹股沟淋巴结清扫,对于有高危因素者,手术结合放疗或（和）化疗能降低其近期复发率。     

外阴癌腹腔镜下腹股沟淋巴结清扫术的研究进展

腹股沟淋巴结转移是影响外阴癌预后的重要因素。传统的开放性腹股沟淋巴结清扫术所带来的手术相关并发症发生率较高，尤其是腹股沟区皮肤坏死、长期不愈，严重影响患者的生活质量，并延迟了术后辅助放化疗，影响患者的预后。腹腔镜下腹股沟淋巴结清扫术能有效避免腹股沟区长切口，减少手术相关并发症，缩短术后恢复时间及住院时间，有利于改善患者的预后。     

外阴癌治疗进展

外阴癌在女性生殖器恶性肿瘤中占３％～５％，以鳞癌为主，占８５％～９０％。国外外阴原位癌的发病７０年代至８０年代上升了一倍，但浸润癌则无明显变化，这可能和ＨＰＶ感染及其他性传播疾病的增多有关。但国内就诊者仍以晚期病例较多。１手术治疗外阴癌的治疗以手术为主。近十余年来外阴癌的处理有如下进展：①对浸润癌患者治疗的个体化。②对局限性肿瘤采用改良的部分外阴根治切除代替全外阴根治切除。③腹股沟淋巴结清扫术采用分切口，保留皮肤及皮下间桥。④Ｔ１期肿瘤浸润深度≤１ｍｍ者不作腹股沟淋巴结（ＧＮ）清扫术。⑤一侧Ｔ１…     

Preservation of the saphenous vein during inguinal lymphadenectomy decreases morbidity in patients with carcinoma of the vulva

BACKGROUND: Traditional inguinal lymphadenectomy includes the removal of a portion of the saphenous vein. The authors hypothesized that preserving the saphenous vein would decrease morbidity without affecting treatment outcome. METHODS: A retrospective review of 83 patients with carcinoma of the vulva who underwent inguinal lymphadenectomy between 1990-1998 was performed. Postoperative short term and long term complications were evaluated. RESULTS: A total of 139 inguinal dissections were performed in 83 patients. The saphenous vein was preserved in 62 patients and ligated in 77 patients. The clinical characteristics of the patients, the operating time, and the estimated blood loss were not significantly different between the two groups. The incidence rate of short term complications including fever, seroma, phlebitis, lymphocyst, and deep venous thrombosis also was similar. Cellulitis occurred in 39% of the patients who underwent vein ligation compared with 18% of the patients who underwent a vein-sparing procedure (P = 0.006). Short term (< 6 months) lower extremity lymphedema occurred in 70% of the vein-ligated group compared with 32% of the vein-spared group (P < 0. 001). Chronic edema (>/= 2 years) was present in only 3% of the patients who underwent saphenous vein preservation compared with 32% of those who underwent vein ligation (P = 0.003). Chronic lymphedema in the vein-spared group was observed in only one patient who received postoperative radiation. Overall, individuals with preservation of the saphenous vein were less likely to develop complications (56% vs. 23%; P < 0.001). There was no difference in the rate of incidence of recurrent disease between the two groups. CONCLUSIONS: Preservation of the saphenous vein during inguinal lymphadenectomy reduces both the short term and long term postoperative complications without affecting treatment outcome. The saphenous vein should be preserved routinely in patients undergoing inguinal lymphadenectomy.     

妇科恶性肿瘤腹股沟区转移淋巴结解剖分布和CTV边界

目的 明确妇科恶性肿瘤腹股沟区转移淋巴结的解剖分布,探讨CTV的勾画边界。方法 回顾分析34例妇科恶性肿瘤并腹股沟淋巴结转移患者。基于腹股沟淋巴结的解剖分布,应用CT和MRI的血管增强扫描影像和Eclipse计划系统的三维重建图像,分析腹股沟区淋巴结与股静脉、大隐静脉及其分支、股部浅筋膜和深筋膜的关系,以及包含95%以上腹股沟淋巴结的CTV边界。结果 34例患者共145个腹股沟转移淋巴结。浅组淋巴结131个,在腹股沟韧带下方,129个位于股部浅筋膜和深筋膜之间。浅组增大淋巴结上群25个在耻骨联合上1 cm以上,沿旋髂浅静脉分布;中群85个在耻骨联合水平,邻近隐静脉汇入股静脉处,11例单个浅组淋巴结转移均在该组;下群21个在耻骨联合下缘以下,沿大隐静脉和股内、外侧浅静脉分布。14个深组转移淋巴结,在股静脉内侧,缝匠肌内侧缘与股静脉后外侧缘连线的后外侧未发现肿大淋巴结。上界:142个淋巴结在耻骨上支上缘以下,3个达股骨头上缘;下界:143个在小转子下缘以上,2个下界达小转子下缘下2 cm。结论 包含98%腹股沟区转移淋巴结CTV边界:前界为浅筋膜,内侧界为腹股沟韧带和股血管后内侧肌肉边缘,后外侧界为股静脉后外侧缘与缝匠肌内侧缘连线,上界为股骨头上缘,下界为小转子下缘。     

Systematic pelvic and aortic lymphadenectomy in elderly gynecologic oncologic patients.

BACKGROUND: Retroperitoneal lymph node dissection is a fundamental step in the surgical management of patients with pelvic gynecologic malignancies, but its applicability to geriatric patients is controversial. The objective of this study was to evaluate whether pelvic and aortic lymphadenectomy in elderly patients with gynecologic malignancies can be a safe procedure in terms of morbidity and mortality. METHODS: In a retrospective case-control study, the authors compared morbidity, mortality, and surgical data in a series of elderly patients (age > 70 years) with endometrial and ovarian carcinoma who underwent surgery. Patients were divided into two groups: Cases were 36 elderly patients who underwent surgery and pelvic and/or aortic lymphadenectomy and were matched with 72 controls, who were patients who underwent surgery without lymphadenectomy. RESULTS: Cases showed a significantly longer median operative time than controls (median, 162 minutes [range, 85-330 minutes] vs. median, 100 minutes [range 20-310 minutes], respectively; P = 0.003). No significant difference between the two groups in terms of blood loss, blood transfusions, intraoperative complications, duration of ileus, reintervention required, or postoperative hospital stay were observed. One patient in the control group died. The type and frequency of severe postoperative complications in the two groups were not substantially different. CONCLUSIONS: Pelvic and aortic lymphadenectomy was performed safely in elderly patients age > or = 70 years with endometrial and ovarian carcinoma without an increase in morbidity and mortality. Advanced chronologic age alone should not be considered a contraindication to full surgical treatment in these patients.     

Evaluation of the videoscopic inguinal lymphadenectomy in melanoma patients

IntroductionA completion or therapeutic inguinal lymph node dissection is a procedure accompanied with a high rate of postoperative complications. A novel, minimally invasive alternative has been developed; the videoscopic inguinal lymphadenectomy. The aim of this study is to present our first experience with the videoscopic inguinal lymphadenectomy among melanoma patients with inguinal metastases.MethodsMelanoma patients with a histologically confirmed inguinal metastases who underwent a videoscopic inguinal lymphadenectomy between November 2015 and January 2018 were included. Outcome measures were operation time, nodal yield, and postoperative complications. Furthermore, lymphedema measurements were performed both subjectively and objectively.ResultsA total of 20 patients (3 males and 17 females) underwent a videoscopic inguinal lymphadenectomy. In 75% of patients the procedure was combined with an open iliac lymphadenectomy. Median operation time of the videoscopic procedure was 110 min (range, 79–165). There were no perioperative complications or conversions. In 12 patients (60%) there was ≥1 postoperative complication. The most frequent complications were seroma and wound infection. All complications were treated conservatively without the need for a surgical re-intervention. The median nodal yield of the videoscopic procedure was 9 (range, 1–19). Lymphedema was present in nine patients (45%) after three months of follow-up.ConclusionOur initial results show that the videoscopic inguinal lymphadenectomy is an attractive alternative to the conventional open technique. The number of complications is comparable with the complication rate reported for the conventional open procedure, but they are less severe and there is no need for a surgical re-intervention.     

Prophylactic Lymphadenectomy vs Observation vs Inguinal Biopsy in Nodenegative Patients with Invasive Carcinoma of the Penis

From 1962 to 1984, 423 patients with invasive penile cancerand negative groin nodes were subjected to prophylactic lymphadenectomies(n113), observations (n258) or inguinal biopsies (n52) in anon-randomised fashion. The numbers of patients with T2, T3and T4 lesions were similar in the three groups. The overallfive-year disease-free survivals were 94, 93 and 85%, respectively.All groin recurrences in the observation group occurred within18 months of the surgery for the primary tumor. The five-yeardisease-free survivals of node-positive patients in the lymphadenectomyand observation groups were 100 and 76%, respectively; threepatients in the latter group had refused surgical treatmentwhen their adenopathy was mobile. Morbidity from the prophylacticlymphadenectomies included wound breakdown in 61%, wound infectionin 18% and lymphedema' in 25% of patients. We feel that neitherprophylactic lymphadenectomy nor inguinal biopsy are justifiedin these patients. Close observation of the groin nodal statuswould be appropriate.     

Evaluation of intraoperative and postoperative complications related to lymphadenectomy in ovarian cancer patients

Assessment of the regional lymph node status is an integral part of diagnostics for ovarian cancer patients. Due to the risk of complications, lymphadenectomy for ovarian cancer patients, as a routine treatment procedure, is still a subject of controversy. Therefore, the present study aimed to evaluate the frequency and nature of intraoperative and postoperative complications in ovarian cancer patients treated with surgery. In addition, a comparison of the frequency and nature of surgical complications between patients who underwent lymphadenectomy and those who did not was carried out. A retrospective analysis of 211 consecutive ovarian cancer patients treated with surgery with pelvic and aortic lymphadenectomy (group I), and 258 ovarian cancer patients treated with surgery but without lymphadenectomy (group II) was carried out. All of the patients were treated with complementary chemotherapy. The frequency and nature of the intraoperative and postoperative complications were determined. The most frequent intraoperative complications in the two groups were haemorrhage, urinary system damage and digestive tract damage. The difference in the frequency and nature between the groups was not statistically significant (p=0.683). The most frequent postoperative complications were haemorrhage, intestinal junction dehiscence, eventrations, wound dehiscence, anaemia, wound healing complications and intestinal fistulas. Haemorrhage, eventrations and wound healing complications were more frequent in group I. The difference was statistically significant (p=0.002). Due to postoperative complications, reoperative procedures were necessary in two women in group II (0.78) and in 15 women (7.11%) in group I. The difference was statistically significant (p=0.000). In conclusion, the most frequent intraoperative complications were haemorrhage, urinary system damage and digestive tract damage. The frequency of complication was found to be similar in the two groups. A statistically significant higher rate of postoperative complications, such as haemorrhage, eventrations and wound healing complications was confirmed in the lymphadenectomy group.