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.

Modified Radical Ingurnal Lymphadenectomy for Penile Cancer(Report of 25 Cases)

Objective： To decrease the postoperative complications by presenting a modified technique of the radical inguinal/ilioinguinal lymphadenectomy for penile cancer with satisfying dissection range as the tranditional standard technique demands for. Methods：25 patients with penile cancer underwent our modified inguinal lymphadenectomy from 2000 to 2008 were reviewed. In the group, dissection was include both the superficial and deep inguinal lymph nodes. The key aspects of the procedure were： shorter skin incision, the relatively thicker flaps developed just beneath Scarpa＇s fascia, the preservation of the saphenous vein, the elimination of the need to transpose the sartorius muscle, and the translocation of the testis and spermatic cordas to cover the thigh vessels as a compensation. Results：The total number of bilateral inguinal lymph nodes dissected was 432. The pathology revealed that 68% cases positive with metastasis （29 positive nodes in 17 patients）. Only one patient encounted wound infection, high fever, skin necrosis and other late complications. Local complications occurred in 16% cases. There was no serious complications as dreadful flap necrosis , injury of the femoral vessels or lymphocele happened. 5-Year Progression-free Survival Rate and Overall Survival Rate were 72% and 76%. Conclusions： The modified radical inguinal lymphadenectomy decreases the complications and relieve the morbidity, while the dissection extent needed by radical treatment is secured.