阴茎癌腹股沟淋巴结清扫术中保留大隐静脉能否减少术后并发症的系统评价

目的 探讨阴茎癌腹股沟淋巴结清扫术中保留大隐静脉能否减少术后并发症的发生.方法 在中国知网、万方、维普、中国生物医学文献数据库、Web of Science、PubMed、Co-chrane Library等电子数据库中进行阴茎癌腹股沟淋巴结清扫术相关文献检索,检索时限从建库至2017年4月1日.由2名研究者独立交叉阅读筛选及提取文献信息,第3名研究员对结果进行对比核查.结果 纳入符合标准的文献共39篇.开放腹股沟淋巴结清扫术组12篇(其中单纯保留大隐静脉组7篇,单纯切除大隐静脉组2篇,有3篇文献同时对比保留大隐静脉组及切除大隐静脉组),腹腔镜下腹股沟淋巴结清扫术组27篇(其中单纯保留大隐静脉组8篇,单纯切除大隐静脉组18篇,有1篇文献同时对比保留大隐静脉组及切除大隐静脉组).保留大隐静脉/不保留大隐静脉的开放腹股沟淋巴结清扫术病例的切口感染率、皮瓣坏死率、淋巴肿发生率、血清肿发生率、下肢水肿发生率差异均有统计学意义(P<0.05).保留大隐静脉/不保留大隐静脉的腹腔镜下腹股沟淋巴结清扫术病例的切口感染率、血清肿发生率、下肢水肿发生率差异亦有统计学意义(P<0.05).结论 无论在开放或是腹腔镜腹股沟淋巴结清扫术中,保留大隐静脉相对于不保留者能显著减少术后并发症的发生.     

Primary superficial femoral vein leiomyosarcoma: Report of a case

The majority of leiomyosarcomas occur in the muscular layers of the gastrointestinal tract and uterus. Primary leiomyosarcomas rarely arise in the veins of the lower extremities. Primary leiomyosarcoma of the superficial femoral vein is extremely uncommon. We herein present a case of a 69-year-old man with a primary leiomyosarcoma of the superficial femoral vein of his left thigh, which manifested as an anteromedial palpable painless mass in the middle third of his left thigh. Duplex ultrasonography revealed a 4 × 8-cm mass attached to the left superficial femoral vein. The mass was removed surgically en bloc. Histological examination showed a low-grade leiomyosarcoma. Seven months after the resection, a local recurrence of the tumor was observed, and the patient underwent another surgery. Five years after the second operation the patient remains free of illness.     

Primary leiomyosarcoma of the great saphenous vein: case report.

OBJECTIVE: To describe a case of primary leiomyosarcoma of the great saphenous vein. PATIENT RECORD: A 59-year-old Chinese lady presented with two painful lumps in the right thigh in the line of the great saphenous vein. At surgery, in September 2004, two tumors in the right great saphenous vein above the knee were excised with the intervening normal vein. Histopathological studies confirmed both masses as leiomyosarcoma. Radiotherapy was given postoperatively. The patient has been followed-up for 300 days after surgery with no evidence of local or distant metastasis. CONCLUSION: Leiomyosarcoma of the great saphenous vein can exist at more than one site. Tumor resection and radiotherapy was associated with good patient prognosis.     

The femoral triangle and superficial veins of the leg

The femoral triangle is important in puncture and exposure of the femoral artery, block dissection of the groin lymph nodes and surgery of the great saphenous vein at its termination. The great (long) saphenous vein passes upwards from in front of the medial malleolus to a hand’s breadth behind the patella to pierce the deep fascia at the groin to enter the common femoral vein. The landmark for this is one finger’s breadth medial to the femoral pulse, which is located halfway between the anterior superior iliac spine and the pubic symphysis. The small (short) saphenous vein commences behind the lateral malleolus and ascends behind the calf to enter the popliteal vein at the popliteal fossa. Both veins have numerous tributaries and perforators, guarded by valves, which join the deep veins. The great saphenous vein relates to the saphenous nerve, the small vein relates to the sural nerve and both may be injured in vein surgery.     

腔镜下阴茎癌双侧腹股沟淋巴结清扫术14例报告

目的探讨腔镜下阴茎癌双侧腹股沟淋巴结清扫术的效果。方法2009年9月～2011年11月对14例阴茎癌行腔镜下双侧腹股沟淋巴结清扫术。术前对腹股沟淋巴结和隐静脉进行多普勒超声扫描和盆腔淋巴CT检查,术中建立人工手术腔隙,置人腔镜以及操作器械,先用超声刀扩大皮下腔隙,向上至腹股沟韧带上方的腹外斜肌腱膜,外侧至缝匠肌外缘,内侧为长收肌内侧,下界为股三角顶端,解剖出股动静脉、大隐静脉及其分支,并切除该范围内的淋巴结和脂肪组织,从穿刺孔取出清扫的淋巴结和脂肪组织,术后置引流管引流。结果14例均顺利完成腔镜下腹股沟淋巴清扫术,术中未发生并发症。手术时间平均103min（95～112min）,术中出血量平均85ml（20～130m1）。双侧切除淋巴结共5—14枚,平均9枚,淋巴结均阴性。术后留置引流管平均5d（3～7d）。术后住院5～8d,平均6d。1例出现淋巴囊肿,2个月后消退,其余患者未发生股血管损伤、皮缘坏死、愈合延迟、皮下积液和淋巴漏等切口相关的并发症。14例术后随访6—20个月,平均9个月,患者无明显双下肢肿胀及活动障碍。结论腔镜下阴茎癌双侧腹股沟淋巴结清扫术可以保证清扫范围并减少标准开放手术带来的切口相关并发症。     

The femoral triangle and superficial veins of the leg

The femoral triangle is important in puncture and exposure of the femoral artery, block dissection of the groin lymph nodes, and surgery of the long (great) saphenous vein at its termination. The long saphenous vein passes upwards from in front of the medial malleolus to a hand’s breadth behind the patella to pierce the deep fascia at the groin to enter the common femoral vein. The landmark for this is one finger’s breadth medial to the femoral pulse, which is located half-way between the anterior superior iliac spine and the pubic symphysis. The short (small) saphenous vein commences behind the lateral malleolus and ascends behind the calf to enter the popliteal vein at the popliteal fossa. Both veins have numerous tributaries and perforators, guarded by valves, which join the deep veins. The long saphenous veins relate to the saphenous nerve, the short vein relates to the sural nerve and both may be injured in vein surgery.     

Extra-anatomical transobturator bypass graft for femoral artery involvement by metastatic carcinoma of the penis: report of five patients

Objectives  Squamous cell carcinoma (SCC) of the penis with inguinal lymph node involvement aggravates prognosis and can cause femoral artery bleeding, hemorrhagic shock and even death. The objective of this study is to describe the use of extra-anatomical transobturator bypass graft for femoral artery involvement by metastatic carcinoma of the penis. Casuistic and method  Five patients with SCC and inguinal lymphatic metastasis involving the femoral vessels, who underwent extra-anatomical arterial bypass through obturator foramen between 1999 and 2007, were reviewed. The surgical technique and the postoperative outcome were described. Results  After extra-anatomical transobturator bypass, all patients presented distal pulses. The mean time of surgery was 6 h. In four patients, a knitted Dacron tube was used; and in one, the contralateral devalvulated greater saphenous vein was used. Concomitantly, two patients underwent mass resection and one patient underwent node dissection 2 weeks after bypass. Two patients chose not to undergo inguinal resection, opting for palliative chemotherapy after the vascular procedure. The average follow-up period was 12 months and four patients have died—three due to pulmonary metastasis, and one due to acute myocardial infarct. No prosthetic complication was identified and no patient presented femoral bleeding. Conclusions  The use of the transobturator bypass can benefit patients presenting with penile SCC and inguinal lymph nodes metastasis involving the femoral vessels, allowing resection of extensive tumor lesions, as well as avoidance of local complications.     

Cardiac metastasis of great saphenous vein leiomyosarcoma

We present a case with cardiac metastasis of the great saphenous vein leiomyosarcoma (LMS) that presented to the emergency department with dyspnea and palpitations 2 months ago. In this patient, hemodynamic instability was caused by an extensive right ventricular cavity and outflow tract invasion of the LMS. Treatment of the patient included incomplete mass resection, adjuvant chemotherapy, and permanent pacemaker implantation (due to postoperative complete atrio-ventricular block).     

Surgical repair of primary saphenous vein aneurysm of the proximal leg after initial presentation as an inguinal hernia

Primary venous aneurysms of the proximal saphenous vein are uncommon. They are most frequently seen in patients referred for evaluation and treatment of an inguinal or femoral hernia. Since 1992 five patients with a proximal saphenous venous aneurysm were referred for evaluation and treatment of an inguinal or femoral hernia. Data from five consecutive patients treated for a proximal saphenous venous aneurysm were analyzed. Four of the five patients were treated successfully by replacing the proximal saphenous venous aneurysm with a 6-mm expanded polytetrafluoroethylene (IMPRA) interposition graft. All grafts were patent 2 years after the surgical procedure by Doppler examination. A primary aneurysm of the proximal saphenous vein can be successfully repaired using a polytetrafluoroethylene interposition graft with long-term patency. Preservation of the saphenous vein should be considered in patients who have a normal distal saphenous vein. Repair of a primary saphenous venous aneurysm preserves the saphenous vein for use as a conduit for later bypass surgery of the leg or heart.     

腹股沟区淋巴静脉分流加硝酸银肾盂灌注治疗乳糜尿的临床疗效

目的 探讨腹股沟区淋巴静脉分流加硝酸银肾盂灌注治疗乳糜尿的疗效。方法 采用2％硝酸银肾盂灌注加同侧腹股沟区淋巴结与大隐静脉主干吻合方法治疗乳糜尿患者28例。其中男16例，女12例，年龄41～68岁，平均46岁。病史6个月～30年，平均3．6年。乳糜尿来自左肾14例，右肾12例，双肾2例。结果 术后3d内尿乳糜试验转阴者8例，7d转阴者17例，11d转阴者3例。27例随访3～12年，复发3例，复发率11％。结论 腹股沟区淋巴静脉分流加硝酸银肾盂灌注是治疗乳糜尿简单、安全、有效的方法，适宜于基层医院开展。     

Inguinofemoral dissection for carcinoma of the vulva: effect of modifications of extent and technique on morbidity and survival

BACKGROUND: The aim of this study was to evaluate the impact of modifications of extent (medial inguinal and medial femoral lymphadenectomy, inguinal lymphadenectomy, inguinal and medial femoral lymphadenectomy, and inguinofemoral lymphadenectomy) and surgical technique of lymphadenectomy (including sartorius transposition, preservation of the fascia lata, and preservation of the saphenous vein) on morbidity, groin recurrence, and survival in patients with vulvar carcinoma. STUDY DESIGN: A retrospective review of 194 patients with primary squamous cell cancer of the vulva was conducted. Clinical, surgical, histopathologic, postoperative short- and longterm complications, and followup data were collected from patient records. RESULTS: Inguinal lymphadenectomy and medial inguinal and medial femoral lymphadenectomy produced about half fewer nodes than did other surgical procedures. On the other hand, number of lymph nodes removed did not differ notably between inguinofemoral lymphadenectomy and inguinal and medial femoral lymphadenectomy. Logistic regression showed that obesity was associated with increased risk of cellulitis. Age greater than 70, obesity, and extent of lymphadenectomy increased wound breakdown risk. Factors associated with leg edema persisting for more than 6 months were: extent of lymphadenectomy, sartorius transposition, and adjuvant irradiation of groin area. With a mean followup time of 38 months, neither groin recurrence rate nor disease-specific survival markedly differed according to technique of lymphadenectomy. CONCLUSION: Techniques of lymphadenectomy with preservation of fascia lata and saphenous vein are associated with a decreased risk of postoperative morbidity without jeopardizing outcomes.     

Occult Deep Vein Thrombosis Due to a Superficial Femoral Artery Aneurysm: A Case Report

We present a case of a superficial femoral artery aneurysm in an 83-year-old female who presented with right thigh pain and a pulsatile mass. Computerised tomography revealed a superficial artery aneurysm, which was subsequently resected and bypassed. The femoral and popliteal veins were found thrombosed and the long saphenous vein was, therefore, spared. Aneurysms of the superficial femoral artery are rare. A complete vein map should be obtained prior to bypass to avoid sacrificing what may then be the most important channel for venous return, the long saphenous vein.     

Surgical treatment of recurrences after operations for essential varices]

Among our cases of post-operative recurrent varicose veins, we report here only those cases which required further surgery. Thus we were able to carry out a comparative study of a series of 30 patients who were re-operated on between the 16th of March 1959 and the 16th of March 1966, and 44 patients operated on under the same conditions between the 16th of March 1966 and the 16th of March 1974. The causes of recurrence were different in the two groups. Before 1966, they were mainly due to the choice of inefficacious operations. Since 1966, they are due to poor technique in resection of the junction of the femoral vein with the saphenous vein. This was the most common cause, and these failures were favoured by saphenous abnormalities. Associated with stripping of the large vessels, resection of inguinal cavernoma which prolonged the femoro-saphenous junction, was the main stage in these re-operations. It was perfectly efficacious in the treatment of varicose veins but required also resection of inguinal lymph nodes with the cavernoma. Post-operative complications, such as lymphatic fistula and oedema, led us to prefer simple isolation of the cavernoma from the deep veins, but the first and essential stage remains resection of the junction of the femoral and saphenous veins and stripping of accessory trunks.     

Modified radical inguinal lymphadenectomy for carcinoma of the penis: technique and results

PURPOSE: Modified radical inguinal lymphadenectomy for carcinoma of the penis is presented that satisfies the requirement for complete groin dissection, while significantly decreasing postoperative complications. MATERIALS AND METHODS: Eight patients with squamous cell carcinoma and 2 with leiomyosarcoma of the penis underwent bilateral modified inguinal lymphadenectomy, including removal of the superficial and deep inguinal lymph nodes. To avoid damage to the vessels of the groin region that run parallel to the inguinal ligament and lie in the fat of the superficial layer of the superficial fascia dissection is done beneath this layer. The proper cleavage plane is just above the membranous layer of the superficial fascia, beneath which the superficial inguinal lymph nodes are located. The saphenous vein is preserved and the sartorius muscle is left in situ, so as not to disturb collateral lymphatic drainage. RESULTS: At a followup of 6 to 104 months no skin necrosis, infection or deep venous thrombosis occurred. In 2 patients early moderate lymphedema of the lower extremities resolved with time, 2 had scrotal edema and 3 had a transient lymphocele. CONCLUSIONS: As described, modified radical inguinal lymphadenectomy decreases the morbidity associated with groin dissection, while removing superficial and deep inguinal lymph nodes.     

Iatrogenic femoral artery pseudoaneurysm surgically repaired with combined bovine pericardial roll and autologous great saphenous vein grafts

Iatrogenic femoral artery pseudoaneurysm caused by invasive procedures is one of the common complications for endovascular interventions.We present a case of a young male with a complex iatrogenic femoral artery pseudoaneurysm as a result of iatrogenic femoral artery puncture.The defective femoral artery was repaired with combined bovine pericardial tube and autologous great saphenous vein grafts.Computed tomography angiography showed the grafts were still patent one year after the surgery.     

Leiomyosarcoma of the external iliac vein

Leiomyosarcoma of the iliac vein is an uncommon tumor. We report a case of a 63-year-old Japanese woman with leiomyosarcoma of the right external iliac vein. The patient complained of right inguinal pain and swelling. Computed tomography demonstrated a mass surrounding the right external iliac artery and vein. Metastases in the lungs and liver were found. Complete resection of the tumor along with the involved vessels was performed. Polytetrafluoroethylene grafts were used to reconstruct the vessels. Pathological examination revealed leiomyosarcoma of the external iliac vein. Although the prognosis of leiomyosarcoma is poor, en bloc tumor resection is the treatment of choice.     

The microvascular technique of vein grafting in rats as a training and experimental model

Techniques for obtaining and implanting vein grafts in the femoral arteries of rats are described. Grafts 5 mm in length can be removed from the femoral vein without ligating any side branches; a 15-mm segment is the maximum graft that can be obtained from the femoral vein in a rat. This requires ligation and division of all the branches between the inguinal ligament and the great saphenous vein. The superficial epigastric vein also can be used as a source of grafts to be used in the femoral artery. In this study, neither the femoral nor the superficial epigastric vein appeared to have functioning valves. Therefore, reversing the vein graft before implantation was not necessary.     

Popliteal vein thrombosis after radiofrequency ablation of greater saphenous vein for varicose vein

Percutaneous endovenous techniques, such as radiofrequency ablation (RFA), have become the preferred method for treatment for varicose veins associated with great saphenous vein (GSV) insufficiency. Reports have shown safety and efficacy of these techniques with relatively few complications. Deep venous thrombosis after RFA is rare and usually involves extension of thrombus from great saphenous vein to common femoral vein, hence the requirement for postoperative ultrasound. We report a case of symptomatic popliteal vein thrombosis after RFA of GSV requiring anti-coagulation.     

Leiomyosarcoma of the splenic vein

Leiomyosarcomas are smooth muscle-derived tumors generally found intra-abdominally in the retoperitoneum, mesentery, or omentum. Only approximately 5% of these tumors originate from vessel wall smooth muscle. Those derived from the splenic vein are exceedingly rare, with only one previously published case in the literature. We present a second case of leiomyosarcoma of the splenic vein in a 58-year-old woman with 2 months of epigastric pain. A distal pancreatectomy was performed to include the tumor found centered in the splenic vein at the splenic and portal vein confluence and growing into the pancreas in the body on the posterior aspect. A saphenous vein patch was used for reconstruction.