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。

Identification and excision of sentinel lymph nodes in endoscopic inguinal lymphadenectomy of vulvar cancer

Objective To identify and excise sentinel lymph nodes in endoscopic inguinal lymphadenectomy of vulvar cancer,and look for pathway of lymphatic transferation of vulvar cancer.Methods Three patients bearing vulvar squamous-cell cancer were enrolled in this study.Methylthioninium chloride injection was subcutaneously and intracutaneously injected at upper outer side of tumors before endoscopic inguinal lymphadenectomy.During the process of lymphadenectomy,blue stained lymph nodes and lymphvessels were found and their locations were confirmed.Results All blue stained sentinel lymph nodes and lymph-vessels were identified and excised,and the sentinel lymph nodes were those located near tuberculum pubicum at upper inner side of superficial epigastric vein.Conclusion Identification and excision of sentinel lymph node is easy under endoscopic inguinal lymphadenectomy of vulvar cancer.Lymph nodes near tuberculum pubicum are significant sentinel lymph nodes of vulvar cancer.