摘要
目的报道一种新的外阴癌根治术的技术可行性和短期临床疗效。方法2019年5月南方医科大学珠江医院妇产科团队对2例外阴恶性肿瘤患者(中分化鳞癌患者ⅢA期1例和恶性黑色素瘤ⅠB期1例)施行了单切口外阴癌根治术(radical vulvectomy and inguinal lymphadenectomy using a single incision,RVIL-SI)。手术范围包括通过单切口行广泛外阴切除术+双侧腹股沟浅深淋巴结清扫术,利用广泛外阴切除术的外上方切口皮下潜行进入股三角区域,不但可以获得良好的术野暴露,还能有效清扫双侧腹股沟浅深淋巴结。结果成功开展2例RVIL-SI新术式。2例广泛外阴切除联合外阴重建的时间分别为63及52 min、双侧腹股沟浅深淋巴结清扫术及股三角缝合的时间分别为65和57 min,出血量均<5 ml。其中第2例患者采用卡纳琳前哨淋巴结检测技术。腹股沟淋巴清扫的数目分别为27和20。2例患者术后腹股沟区域"蝴蝶形"加压包扎3 d,外阴切口术后第5天开始采用高锰酸钾1∶5 000 ml盆浴。术后随访1个月,外阴切口Ⅰ级痊愈,腹股沟区域愈合良好,未见皮瓣区域的皮肤感染或坏死等并发症。结论RVIL-SI作为一种新的外阴癌根治术,避免了腹股沟区域切口,并能实现外阴广泛切除和腹股沟浅深淋巴结清扫,特别是能够对"桥部区域"淋巴进行清扫,其技术安全可行。尽管短期随访效果满意,但肿瘤治疗安全性有待更多的病例及更长的随访时间加以证明。
Objective To describe a novel procedure of radical vulvectomy and inguinal lymphadenectomy using a single incision (RVIL-SI) for the treatment of vulvar malignancy. Methods In March, 2019, two cases affected with vulvar cancer (the first one is stage ⅢA squamous cell carcinoma and the second one is stage ⅠB with malignant melanoma) underwent this novel procedure, which was characterized by the combination of radical vulvectomy and bilateral inguinal lymphadenectomy without making additional incisions in groin areas. The boundaries of femoral triangle could be exposed perfectly using the initial incision of radical vulvectomy and the combined superficial and deep groin lymph node dissection were done subcutaneously from medial to lateral. Preoperative data and short term follow-up outcomes were collected. Results The RVIL-SI was successfully conducted in two patients without any incisions of groin. The great saphenous veins were all spared. The operative time, average blood loss and median total regional lymph nodes of two cases were close. No major intraoperative complications occurred. Micrometastasis in one right superficial inguinal node was found in the first case with ipsilateral huge cancer lesion. No drain tube was left in inguinal areas intraoperatively. On postoperative day 3, the second case suffered mild lymphocele of right groin, which was resolved via repeated percutaneous needle puncture followed by elastic compression. Postoperative hospital stay of two cases were 10 and 11 days, respectively. With no skin complication at the time of writing this report. Conclusion Our preliminary experience with the RVIL-SI has confirmed the reproducibility and minimal invasive therapeutic potential in the treatment for patients with vulvar cancer. But this novel procedure is in its infancy stage. Although short-term results are encouraging, a larger series with longer follow-up are required to fully evaluate the therapeutic efficacy.
作者
王沂峰
陈高文
马颖
郑友红
何丽清
何武奇
戴戈扬
周宇凤
陈燕英
刘敏娟
冯婉琴
Wang Yifeng;Chen Gaowen;Ma Ying;Zheng Youhong;He Liqing;He Wuqi;Dai Geyang;Zhou Yufeng;Chen Yanying;Liu Minjuan;Feng Wanqin(Department of Obstetrics and Gynecology,Zhujiang Hospital,Southern Medical University, Guangzhou 510282,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2019年第31期2450-2454,共5页
National Medical Journal of China
