摘要
目的 探讨在腔镜腹股沟淋巴结清扫术（VEIL）中应用基于解剖标示下的区域淋巴结整块清除法的可行性。方法 在2012年5月至2014年3月间对5例阴茎癌患者行双侧VEIL。术中将Camper’s筋膜浅层、股血管表面、内收肌的外侧缘、缝匠肌的内侧缘、腹股沟韧带上2cm、股三角的顶部作为清扫范围的解剖标示,建立前、后、左、右、上、下6个解剖平面,将区域内的腹股沟浅组及深组淋巴结、阔筋膜、大隐静脉节段等组织整块清除。结果 所有患者均顺利完成手术,手术时间（63.5±8.8）min/侧,引流管拔除时间（6.6±1.4）d,淋巴结清扫数目（9.4±2.7）枚/侧,其中1例患者在双侧腹股沟区均检出阳性淋巴结（左侧5枚,右侧1枚）和组织癌结节（左、右各1枚）,整个手术过程基本无出血。并发症包括血清肿1侧,下肢水肿1侧,术后总并发症发生率20%（2/10）。中位随访时间为22个月（13~35个月）,清扫术中检出阳性淋巴结的患者术后5个月出现皮肤转移,其余患者未出现局部复发和远处转移。结论 在VEIL中采用基于解剖标示下的区域淋巴结整块清除法安全、可行,并发症发生率低,同时降低手术难度,缩短学习曲线,有利于术式标准化及推广。
Objective To explore the feasibility of regional lymph node dissection based on anatomic landmarks in video endoscopic inguinal lymphadenectomy （VEIL）. Methods Bilateral VEIL was performed in 5 cases of penile cancer during May 2012 and Mar. 2014. During operation, Camper＇s superficial fascia, superficial femoral artery, adductor outer edge, sartorius inner edge, area 2 cm above the inguinal ligament, and the top of triangle stocks served as anatomic landmarks of dissection, and then tissues with the superficial inguinal lymph node, deep lymph nodes, fascia lata, and saphenous vein were removed. Results All operations were successful. The operative time was （63.5 ± 8.8）min/side, drainage tube removal time was （6.6± 1.4）days, and the number of dissected lymph nodes was 9.4±2.7/side. One patient had positive lymph nodes （left 5, right 1） and tissue nodules （left 1, right 1） in the inguinal region. No intraoperative bleeding occurred. Postoperative complications included seroma in 1 case, and leg edema in 1 case. The total postoperative complication rate was 20% （2/10）. Median follow-up time was 22 months （13-35 months）. The patient who had positive lymph node during dissection developed skin metastasis 5 months after surgery. Other patients had no local recurrence or distant metastasis. Conclusions Regional lymph node dissection based on anatomic landmarks in video endoscopic inguinal lymphadenectomy is simple, safe and feasible, with advantages of low complication rate, and shorter learning curve. It is worth of standardization and promotion.
出处
《现代泌尿外科杂志》
CAS
2015年第11期790-793,共4页
Journal of Modern Urology
