阴茎癌根治性髂腹股沟淋巴结清扫术的改进

目的:对根治性髂腹股沟淋巴结清扫手术进行改进,以完整清除淋巴结并减少术后并发症。方法:2003~2004年对20例阴茎鳞状细胞癌患者施行根治性腹股沟淋巴结清扫,其中5例还施行了髂淋巴结清扫。腹股沟区的清扫范围包括腹股沟浅组和深组淋巴结,采用暴露好的直切口,皮瓣厚度适中,切断大隐静脉且不转移缝匠肌。髂淋巴结清扫采用下腹正中切口,术后采用逐步降低的负压吸引促进引流和皮瓣愈合。结果:两侧腹股沟区淋巴结平均为21个,阳性淋巴结平均为1.6个。术后病理检查证实55%的患者有淋巴结转移,纠正了40%的术前分期。术后有1例出现高热和局部感染,另有27.5%的单侧腹股沟区域出现局部并发症,包括皮缘坏死、愈合延迟、皮下积液和淋巴瘘。无一例出现大面积皮片坏死和股血管损伤。结论:改进的根治性髂腹股沟淋巴结清扫手术保证了清扫范围,减少了手术并发症。

Modified radical ilioinguinal lymphadenectomy for penile cancer

Objective:Modified radical ilioinguinal lymphadenectomy for penile cancer is presented that satisfies the requirement for complete dissection,while decreasing postoperative complications.Methods:A total of 20 patients with squamous cell carcinoma of the penis underwent modified inguinal lymphadenectomy from 2003 to 2004 were reviewed.In this group,5 patients also received pelvic lymphadenectomy via a median abdominal incision.The superficial and deep inguinal lymph nodes were included in inguinal lymphadenectomy via a vertical skin incision.The key points for the surgical procedure were: keep the proper cleavage plane,do not preserve the saphenous vein and leave the sartorius muscle in situ.The sequential bilateral lymphatic drainage was used after surgery.Results:The average number of bilateral inguinal lymph nodes and metastatic nodes was 21 and 1.6,respectively.The pathological examination revealed that 55% cases presented with metastasis,and the stage was corrected in 40% cases.One patients encounted wound infection and high fever after surgery.Local complications occurred in 27.5% cases.There was no flap necrosis or injury of the femoral vessels.Conclusions:Modified radical ilioinguinal lymphadenectomy decreases the complications associated with lymph node dissection,while removing ilioinguinal lymph nodes radically.