阴茎切除术和同期改良腹股沟淋巴结清扫术治疗阴茎癌10例的近期疗效

目的 总结阴茎切除术和改良腹股沟淋巴结清扫术同期治疗阴茎癌的近期临床效果.方法 术前5-7天使用抗菌药,阴茎局部及腹股沟区高锰酸钾溶液泡洗,先行阴茎部分切除术或阴茎全切+会阴尿道造口术,同期行改良腹股沟淋巴结清扫术.清扫时皮肤切缘缝线作为牵引,沿浅筋膜浅层和浅筋膜深层之间少血管平面分离,术后皮瓣下置多孔引流管接负压吸引,皮瓣用丝线固定于相应位置的深筋膜处,皮缘处分浅筋膜浅层,皮肤两层缝合.结果 中位术后住院日14天(范围10～18天),出院时伤口痊愈或仅有小的并发症.伤口部分裂开1侧.皮肤切口边缘坏死6侧(30%),无腹股沟皮瓣感染或深静脉血栓.无下肢淋巴水肿、淋巴囊肿或血肿.随访1-28个月.平均18个月.无瘤生存10例,无阴茎或腹股沟处复发.结论 阴茎切除术和改良腹股沟淋巴结清扫术同期治疗阴茎癌,并发症发生率无增高.采用改良的腹股沟清扫术可以降低并发症的发生率.由于病例数少,随访时间短,对预防腹股沟淋巴结复发和提高患者长期生存率有待进一步的临床研究.

Contemporary morbidity from penectomy and immediate modified inguinal lymphadenectomy for penile carcinoma in 10 paients

Objectives The comtemporary morbidly from penectomy and immediate modified inguinal lymphadenectomy for penile carcinoma was assessed.Methods A broad-spectrum parental antibiotics was given 5 to 7 days preoperatively.Wash the operative site with 1:5000 permanganic acid solution from admission.After partial penectomy or total penectomy and perineal urethrostomy,immediate modified inguinal lymphadenectomy was performed.The extention of our modified inguinal lymphadenectomy was similar with that described by Catalona WJ.Place suture traction on the skin flap and handle the flap gently.Dissect carefully beneath the superficial layer of the superficial fascia,assessing the proper cleavage plane to avoid damage to the vessels and spare skin vascularization.Insert a suction drain through nondissected areas,which was connected with a vacuum aspiration device.The flap was fixed by non-absorbable sutures that incorporated the superficial layer of the superficial layer of the superficial fascia and the correspondent deep fascia.Close the skin and the superficial layer of the superficial fascia,respectively.Results The duration of postoperative hospitalization ranged from 10 days to 18 days,with a median of 14 days.The skin flaps healed with no complication or minor complications.There was incision decoherence in 1 groin and small flap edge necrosis in 6 (30% ) groins.There were no large skin flap necrosis,no deep venous thrombosis,no lower extremity edema,no lymphocele or hematoma.The duration of followup ranged from 1 month to 28 months,with a mean of 18 months.Ten patients all survival without recurrence.Conclusions Contemporary morbidity from penectomy and immediate modified inguinal lymphadenectomy for penile carcinoma did not increase.The morbidity decreased indeed by our modified inguinal lymphadenectomy. However,further clinical investigation is required to confirm the advantage and long-term effect of our modified techniques.