阴茎癌改良根治性腹股沟淋巴结清扫术25例报告

目的：将阴茎癌腹股沟淋巴结清扫手术进行改良,以期降低术后并发症的发生率及其严重程度.方法：2000～2008年对25例阴茎癌患者施行改良根治性腹股沟淋巴结清扫术.清扫范围包括腹股沟浅组和深组淋巴结,清除区域内Scarper＇s筋膜下脂肪及纤维组织,不切断大隐静脉主干,旋转带精索的睾丸及鞘膜覆盖股管,而不离断和转移缝匠肌.结果：两侧腹股沟区淋巴结共检出432枚,平均17.3枚,病理证实阳性共17例29枚淋巴结,68%的患者淋巴结转移.术后1例患者出现高热、切口感染、皮缘坏死及远期并发症,另有16%的单侧腹股沟区域出现局部并发症,包括皮缘轻度坏死及愈合延迟、阴囊水肿、淋巴漏.无一例出现严重的大片皮肤坏死、股血管损伤、淋巴管瘤、下肢运动障碍等严重的并发症.五年无进展生存率和总生存率分别为72%和76%.结论：改良根治性腹股沟淋巴结清扫手术保证根治性清扫范围的同时,减少了手术并发症.     

减少阴茎癌腹股沟淋巴结清扫术并发症的临床技巧研究(附30例报告)

目的探讨减少阴茎癌腹股沟淋巴结清扫术后并发症的手术操作技巧及其效果。方法回顾性分析2000年1月至2011年10月间收治的30例行改进根治性双侧腹股沟淋巴结清扫术的阴茎癌患者的临床资料。30例共60侧行腹股沟淋巴结清扫,其中29例为阴茎癌手术时同期淋巴清扫。清扫范围足够,淋巴结清除彻底,改进技术包括设计腹股沟"S"形皮肤切口、通过确认Campas筋膜的膜性解剖标志层来分离皮瓣、皮瓣边缘缝线牵引、完整保留阔筋膜、尽可能保留阴部外浅静脉、术后良好的引流及加压包扎。结果 30例患者随访5～128个月,共发生并发症15侧次(25.0%),其中轻度皮瓣坏死4侧次(6.7%)、切口感染3侧次(5.0%)、淋巴水肿8侧次(13.3%),无下肢深静脉血栓。结论通过改进腹股沟淋巴结清扫术可有效减少阴茎癌患者腹股沟淋巴结清扫术后并发症。     

腹股沟皮桥在阴茎癌髂腹股沟淋巴结清扫中的应用

目的 探讨腹股沟皮桥在阴茎癌髂腹股沟淋巴结清扫术中的应用.方法 2007年5月全2008年7月,对12例阴茎鳞状细胞癌患者行双侧髂腹股沟淋巴结清扫术,手术取腹股沟韧带上下方两个平行的横行切口.游离两切口间的皮瓣,形成腹股沟皮桥.经上方切口行髂淋巴结清扫后,于腹股沟皮桥下整块切除腹股沟浅、深组淋巴结,并保留大隐静脉.结果 12例患者中,无一例发生切口皮缘的缺血、坏死或感染.10例(83.33%)的4个切口均Ⅰ期愈合,余2例各有1个切口因淋巴渗液而延期愈合.3例(25.00%)轻微双下肢水肿.随访中4例(33.33%)出现不同程度的阴茎、阴囊水肿.包括2例下肢水肿者.结论 腹股沟皮桥技术有助于保护腹股沟区皮瓣的血供,能显著减少甚至避免皮缘缺血、坏死的发生.     

改良技术减少阴茎癌根治性腹股沟淋巴结清扫术后皮瓣坏死的效果分析

目的 探讨改良技术减少阴茎癌根治性腹股沟淋巴结清扫术后皮瓣坏死的方法与疗效. 方法 回顾性分析2002年6月至2010年6月63例阴茎癌126侧改良根治性腹股沟淋巴结清扫术患者资料,清扫范围按照经典的根治性腹股沟淋巴结清扫术方法,减少皮瓣坏死改良技术包括:S形切口,在膜性解剖标志引导下精确分离皮瓣层面. 结果 63例随访12～ 93个月,共发一并发症37侧次,其中轻度皮瓣坏死7侧次(5.6％),切口感染3侧次(2.4％),淋巴水肿19侧次(15.1％),血清肿2侧次(1.6％),淋巴囊肿5侧次(4.0％),下肢深静脉血栓形成1侧次(0.8％).未发生并发症106侧(84.1％),发生1次或2次轻度并发症20侧次(16.0％). 结论 改良根治腹股沟性淋巴结清扫术中采用S形切口和膜性解剖标志精确分离皮瓣层面技术,可减少术后皮瓣坏死发生率.     

三切口侧入法腔镜下腹股沟淋巴结清扫术的可行性研究(附23例报告)

目的:通过创立微创腹股沟区三切口侧入法,自腹股沟区上外侧进入腹股沟皮下,施行腹股沟淋巴结切除术,探讨其可行性、切除淋巴结数量及手术的安全性。方法:取倒三角形的腹股沟区为手术野,对23例符合外阴癌腹股沟淋巴结清扫术的患者,取腹股沟区上外侧髂前上棘下2~3 cm处作为第一穿刺孔,于其下分别相隔2~3 cm取第二、第三穿刺孔,在施行溶脂吸脂术后,分别穿刺10 mm、5 mm Trocar,置入器械行淋巴结切除术。结果:腹股沟侧方的三切口可方便地进行腔镜手术操作,容易地切除浅组、深组淋巴结,23例患者腹股沟区每侧切除的淋巴结数量平均(7.9±3.9)枚;技术成熟后的后20例每侧平均(8.5±3.9)枚。术中无麻醉、手术并发症发生,术后腹股沟创面愈合后皮肤表面平坦,皮色正常,三切口疤痕小。术后22例为Ⅰ期愈合,另1例合并糖尿病者腹股沟区延期愈合。结论:三切口侧入法腔镜腹股沟淋巴结清扫术切除淋巴结数量可达到常规手术的标准;创面Ⅰ期愈合率显著优于常规大切口手术;本切口同时兼顾了美容作用,值得临床应用。     

腹腔镜腹股沟淋巴结清扫术治疗阴茎癌20例报告及随访分析

阴茎癌是一种比较少见的恶性肿瘤,目前阴茎癌的治疗仍以手术为主,联合放疗、化疗等.淋巴转移是阴茎癌主要的转移途径,而腹股沟淋巴结是转移的首站,因此,腹股沟淋巴结清扫术是手术治疗阴茎癌的重要步骤[1].开放和改良腹股沟淋巴结清扫术切口大,切除皮下组织多,术后极易发生腹股沟区皮肤缺血坏死或淋巴瘘,造成切口长期愈合不良等并发症,皮桥式腹股沟淋巴结清扫也存在切口大、愈合慢的问题,均严重影响患者术后的恢复及后期治疗[2].我科2014年6月至2017年5月对20例阴茎癌患者行腹腔镜腹股沟淋巴结清扫术,现报告如下.     

超薄皮瓣在腹股沟淋巴结清扫术中的应用

皮瓣坏死是腹股沟淋巴结清扫术后的最常见并发症。我们自1991年8月至1998年4月,在16例腹股沟淋巴结清扫术中运用了超薄皮瓣,显著地降低了切口皮瓣坏死发生率,报告如下:     

老年患者行腹股沟淋巴结清扫手术的并发症及防治对策

目的探讨老年患者行腹股沟淋巴结清扫手术后的并发症及防治对策。方法 14例70岁以上患者在复旦大学附属肿瘤医院施行了腹股沟淋巴结清扫手术。术前详细评估了肿瘤分期及相关并发病的情况,患者根据体质情况进行美国麻醉师协会（American Society of Anesthesiologists,ASA）评分。按ASA评分后6例患者评分I级,7例Ⅱ级,1例Ⅲ级。手术范围为根治性淋巴结清扫的范围,在手术技术上进行了改良。术后并发症按发生的时间、部位和严重程度分为早期和晚期并发症、局部和全身并发症、轻微和严重的并发症。结果本组患者中有9例施行了双侧腹股沟淋巴结清扫术,5例行单侧清扫手术。所有患者的手术均顺利完成,术后早期全身并发症中轻微并发症占7%,严重并发症占14%;术后早期局部并发症中轻微并发症占30%,无严重并发症;术后晚期并发症中轻微并发症占21%,无严重并发症。结论老年患者行腹股沟淋巴结清扫手术是可行的,局部并发症与较年轻的患者类似,但是需要注意全身并发症的监测。     

阴茎癌同期改良与传统腹股沟淋巴结清扫的病例对照研究

目的探讨非腹股沟深组淋巴结转移的阴茎癌同期行改良腹股沟淋巴清扫的可行性和效果。方法回顾分析本院2010年3月至2012年11月间行改良腹股沟淋巴清扫术(35例)以及传统腹股沟淋巴清扫术(31例)患者的临床资料,记录两组病例的手术时间、术中出血量、术后皮瓣坏死情况和术后住院时间。改良组采用了包括①平行的小切口;②冷刀分离枝术;③吸引器负压吸引等新方法。统计方法采用病例对照研究。结果改良组术后恢复明显好于对照组,两组患者术后皮瓣坏死情况、住院时间的比较,差异均有统计学意义(P<0.05),但手术时间、出血量的比较差异无统计学意义(P>0.05)。两组均治愈出院。结论阴茎癌切除同期行改良根治性腹股沟淋巴结清扫术不增加手术后并发症,是适合阴茎癌患者的治疗策略。     

达芬奇机器人腹股沟淋巴结清扫术治疗外阴癌的临床效果与手术策略

目的：探讨机器人辅助行腹股沟淋巴结清扫术治疗外阴恶性肿瘤的手术安全性及临床效果,为其在妇科良、恶性疾病中的应用提供经验和参考。方法对第四军医大学西京医院妇产科以达芬奇成功实施首例腹股沟淋巴结清扫术的临床资料及手术策略、技巧进行回顾性评价。结果完成的双侧腹股沟淋巴结清扫范围达到根治术要求,未中转开腹。手术平均每侧历时85 min;术中平均每侧出血量均小于10 ml;手术清扫淋巴结平均每侧12个,引流量平均每日53（55±11） ml。患者术后次日即可进食、下床活动,第5日拔除双侧引流管后出院。随访至今,未发生腹股沟区皮肤坏死、切口延迟愈合及淋巴水肿等术后并发症。结论外阴癌病灶局部切除同时联合 Da Vinci 系统行腹股沟淋巴结清扫增加手术安全性,术后并发症减少,患者生存质量提高,可以达到开放性手术切除淋巴结的同样效果,不影响手术的根治性。     

Morbidity of inguinal lymphadenectomy for invasive penile carcinoma

OBJECTIVE: To determine the incidence and the consequences of complications related to modified and radical inguinal lymphadenectomy in patients with invasive penile carcinoma, defined by invasion of the corpus spongiosum or cavernosum (> or =T2). MATERIALS AND METHODS: A total of 118 modified (67.0%), and 58 radical (33.0%) inguinal lymphadenectomy were performed in 88 patients between 1989 and 2000. To decrease the morbidity, radical inguinal lymphadenectomy was proposed only in patients with palpable inguinal lymph nodes, uni- or bilaterally (N1 or N2). Modified inguinal lymphadenectomy was performed bilaterally in patients with invasive penile carcinoma and non-palpable inguinal lymph nodes (N0), and unilaterally in the side without inguinal metastases in N1 patients. Complications were assessed retrospectively with a median follow-up of 46 months and classified as early (event observed during the 30 days after the procedure) or late (event present after hospitalisation or after the first months). RESULTS: A total of 74 complications after 176 procedures were recorded. After modified inguinal lymphadenectomy, 8 early (6.8%) and 4 late (3.4%) complications were observed. There were a total of 110 dissections with no complications and 8 dissections with 1 or 2 complications. After radical inguinal lymphadenectomy, the morbidity increased with 24 early (41.4%) and 25 late (43.1%) complications, observed in only 18 of 58 radical procedures. Leg oedema was the most common late complication, interfering with ambulation in 13 cases (22.4%). CONCLUSION: Modified inguinal lymphadenectomy, with saphenous vein sparing and limited dissection offers excellent functional outcome in patients with invasive penile carcinoma and nonpalpable inguinal lymph nodes. The morbidity after radical lymphadenectomy still significant, especially in patients with multiple or bilateral superficial inguinal lymph nodes treated by pelvic and bilateral inguinal lymphadenectomy.     

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.     

Long-term followup of penile carcinoma treated with penectomy and bilateral modified inguinal lymphadenectomy

PURPOSE: We evaluated modified inguinal lymphadenectomy in the treatment of penile carcinoma, analyzing the rate of complications compared to complete inguinal lymphadenectomy, the complications in performing lymphadenectomy and penectomy concomitantly, and the long-term locoregional recurrence rate. MATERIALS AND METHODS: A total of 26 patients with squamous cell carcinoma of the penis were clinically assessed, and underwent penectomy and bilateral modified inguinal lymphadenectomy at the same operative time. Frozen section analysis of lymph nodes was performed and if metastases were detected a complete ipsilateral inguinal dissection was performed. RESULTS: A total of 52 modified lymphadenectomies were performed. In 10 procedures lymph node metastasis was present. Clinical staging presented false-positive and false-negative rates of 50% and 7.9%, respectively. The complication rate for modified lymphadenectomy was 38.9% and for complete inguinal lymphadenectomy it was 87.5%. Followup ranged from 5 to 112 months and mean followup of recurrence-free cases was 78 months (range 38 to 112). A total of 18 patients underwent bilateral negative modified inguinal lymphadenectomy and 2 of these experienced locoregional recurrence within 2 years after surgery. CONCLUSIONS: Modified inguinal lymphadenectomy causes a lower complication rate than complete inguinal lymphadenectomy. Bilateral modified inguinal lymphadenectomy performed at the same time as penectomy does not increase the complication rate. When frozen section analysis is negative bilaterally, 5.5% of inguinal regions might still harbor occult metastasis. Modified inguinal lymphadenectomy is recommended as a staging procedure in all patients with T2-3 penile carcinoma. A straight followup is required for 2 years since all recurrence was within this period.     

Transperitoneal laparoscopical iliac lymphadenectomy for treatment of malignant melanoma

Background: Current treatment for melanoma of the lower limb includes excision of the primary tumor with ilioinguinal lymphadenectomy in the case of lymph node metastases. The standard surgical approach includes sectioning of the inguinal ligament to gain access to the iliac nodes. More recently, some authors have reported that extraperitoneal laparoscopically assisted ilioinguinal lymphadenectomy for the treatment of malignant melanoma is feasible and less aggressive than standard open surgery. So far, no publications have described transperitoneal laparoscopic iliac lymphadenectomy (TPLND). Methods: From November 2001 to June 2002, 13 patients with ilioinguinal node melanoma metastases underwent TPLND (stage IIIA in 1 case, IIIB in 5 cases, IIIC in 4 cases, and IV in 3 cases). Results: In all 13 cases, the TPLND and groin dissection was performed correctly. Operative time, intra- and postoperative complications, number of lymph nodes retrieved, immediate morbidity, hospital stay, and feasibility of TPLND were evaluated. Conclusions: This study was conducted to evaluate the feasibility and the preliminary results of TPLND used to manage malignant melanoma of the lower limb. This approach has many advantages over the traditional procedure: less surgical trauma, no incision of the abdominal muscles or the inguinal ligament, and less postoperative pain. Moreover, as compared with extraperitoneal laparoscopically assisted ilioinguinal lymphoadenectomy, it provides an improved view of the operative area, dissection zone, and surrounding structures. Further research is needed to confirm these preliminary results regarding the potential applications of this method for treating malignant metastasis to the lower limb.     

33例阴茎癌的外科治疗分析

目的:探讨阴茎癌合理的外科治疗方法。方法:回顾性分析2008年1月~2012年12月间收治的33例阴茎癌患者的临床资料:鳞状细胞癌患者31例,疣状癌患者2例。5例行阴茎局部病变切除术,26例行阴茎部分切除术,2例行阴茎全切加会阴部尿道造口术。行腹股沟淋巴结清扫术20例,其中7例行双侧改良根治性腹股沟淋巴结清扫术,10例行一侧改良根治性腹股沟淋巴结清扫术+对侧改良腹股沟淋巴结清扫术,3例行髂腹股沟淋巴结清扫术+对侧改良腹股沟淋巴结清扫术。结果:33例患者定期随访1~5年,平均随访31个月,1年生存率为93.9%(31/33),2年为87.9%(29/33),5年为72.7%(24/33)。本组6例T1G2期以上阴茎癌患者行预防性腹股沟淋巴结清扫术,术后随访生存率为83%(5/6);而另有14例未行腹股沟淋巴结清扫术,术后随访死亡7例,生存率为50%(7/14)。在33例阴茎癌患者中,9例可扪及单侧或双侧腹股沟淋巴结,行双侧淋巴结活检,有6例为阳性,阳性率高达66.7%(6/9);但有3例阴性患者随访过程中出现腹股沟淋巴结转移,假阴性率为13%(3/23)。有7例伴髂、腹股沟淋巴结转移,随访期间7例患者全部死亡,结论:对阴茎癌患者,合理地选择手术方式切除肿瘤,并合适地选择行腹股沟淋巴结清扫的时机和方式,采用一定的手术技巧,可明显提高患者生存率并减少并发症。     

髂腹股沟淋巴清扫对阴茎癌的治疗意义(附63例报告)

目的 探讨腹股沟淋巴结活检脑髂腹肌沟淋巴清扫在阴茎癌治疗中的作用.方法 报告1982年1月１９９７年７月收治的６３例陈茎癌的临床资料,在节切除阴茎原发病灶同时行无选择性双侧腹股沟淋巴结活检,并对淋巴结活检阳性者行双侧髂腹股沟淋巴清扫术。结果 １１例（１５侧）淋巴结活检阳性,１例假阴性。淋巴清扫后,原活检阴性侧髂腹股沟未见淋巴转移,阳性侧有１例,存在Ｃｌｏｑｕｅｔ淋巴结转移。结论 在切除阴茎癌肿的同时应作双     

改良内镜下腹股沟淋巴结清扫术医护配合

目的 总结探讨改良内镜下腹股沟淋巴结清扫术（VEIL）的医护配合经验,为更好配合内镜手术开展及推广提供支持.方法 回顾性总结我院2010年4月至2013年12月9例行双侧改良内镜下腹股沟淋巴结清扫术的阴茎癌患者医护配合特点,统计相关数据.结果 9例患者（18侧）手术在医护配合下均成功完成,单侧手术时间79～121 min,平均时间97 min,手术清扫淋巴结7～11个,平均8个,每例患者术中出血量45～90 ml,平均51ml,无中转开放,无术中并发症;术后除1例患者发生淋巴漏外,无一例发生皮瓣坏死或切口延迟愈合,无出现腘窝血管压迫及压疮.结论改良内镜下腹股沟淋巴结清扫术在保证肿瘤根治效果的同时降低了手术难度,降低了并发症发生率,注意术中医护配合细节,可更好的完成手术,利于该术式规范化及推广.     

Endoscopic lymphadenectomy for penile carcinoma

BACKGROUND AND PURPOSE: Groin dissection remains the gold standard for the treatment of penile carcinoma that has metastasized to the inguinal lymph nodes. However, it is associated with wound-related complications. Modified groin dissection offers a less-radical approach without compromising oncologic outcomes. We present our technique for endoscopic lymphadenectomy for penile carcinoma (ELPC). PATIENTS AND METHODS: Eight patients with clinical stage T(2) N(0-3)M(0) penile carcinoma underwent ELPC. Preoperative Doppler ultrasound mapping of the inguinal lymph nodes and the saphenous vein was performed. RESULTS: Fourteen lymphadenectomies, including superficial with or without deep inguinal and pelvic-node dissection, were completed in eight patients. The median operative time was 91 minutes (range 50-150 minutes), and the mean number of nodes removed was 9 (range 4-15). No perioperative complications occurred. Lymphoceles developed in three groins (23%). No wound-related complications were seen. CONCLUSIONS: The ELPC is a safe and feasible technique that appears to diminish the wound-related complications associated with the standard open approach.