经腹壁“一步法”腹腔镜下阴茎癌淋巴结清扫术临床疗效

Clinical effect of transabdominal one-step laparoscopic lymph node dissection for penile carcinoma

目的分析经腹壁“一步法”腹腔镜下阴茎癌淋巴结清扫术的有效性。方法回顾性分析了苏州大学附属第一医院2016年1月至2022年5月收治的44例因阴茎癌需行淋巴结清扫的患者的临床资料,其中14例行经腹壁“一步法”腹腔镜下阴茎癌淋巴结清扫(A组),10例行经大腿腔镜下双侧腹股沟淋巴结清扫(B组),20例行开放下双侧腹股沟淋巴结清扫(C组)。结果A、B和C组术后引流量差异无统计学意义(P>0.05);A组平均术中出血量少于B组,差异有统计学意义(P<0.05);A组平均术后住院天数小于B组和C组,差异有统计学意义(P<0.05);A组平均淋巴结清扫个数大于B组及C组,差异有统计学意义(P<0.05);A组VAS评分小于B组及C组,差异有统计学意义(P<0.05)。C组有4例发生切口延迟愈合,3例切口感染;B组有3例发生切口延迟愈合,1例术后肠梗阻;A组发生1例切口裂开,1例淋巴漏。所有并发症经对症支持治疗后均缓解。术后病理结果均为阴茎鳞状上皮癌,切缘未见癌细胞浸润。随访半年,C组有2例发现远处转移,其中1例出现死亡;B组有1例出现周围股骨转移,A组术后半年复查未见明显异常。结论经腹壁“一步法”腹腔镜下阴茎癌淋巴结清扫术安全有效,术中出血少,淋巴清扫范围充分,术后恢复较快,并发症较少,控瘤效果好。

Objective To analyze the superiority of one-step laparoscopic lymph node dissection for penile carcinoma via abdominal wall.Methods The clinical data of 44 patients who needed lymph node dissection due to penile cancer admitted to the First Affiliated Hospital of Soochow University from January 2016to May 2022 were retrospectively analyzed.Among them,14 cases underwent transabdominal“one-step”laparoscopic penile cancer lymph node dissection(group A);10 cases underwent laparoscopic bilateral inguinal lymph node dissection through the thigh(group B);20 cases underwent open bilateral inguinal lymph node dissection(group C).Results There was no significant difference in postoperative drainage volume among the three groups(P>0.05).The average intraoperative blood loss in group A was less than that in group B,and the difference was statistically significant(P<0.05).The average postoperative hospital stay in group A was less than that in group B and group C,and the difference was statistically significant(P<0.05).The average number of lymph nodes dissected in group A was higher than that in group B and group C,and the difference was statistically significant(P<0.05).The VAS score of group A was lower than that of group B and group C,and the difference was statistically significant(P<0.05).There were 4 cases of delayed wound healing and 3 cases of wound infection in group C.In group B,3 cases had delayed wound healing and 1 case had postoperative intestinal obstruction.One case of incision dehiscence and one case of lymphatic fistula occurred in group A.All complications were relieved after symptomatic and supportive treatment.The postoperative pathological results were all penile squamous carcinoma,and no cancer cell infiltration was observed at the surgical margin.Two patients in group C were found to have distant metastasis,and one of them died.In group B,there was 1 case with peripheral femur metastasis.In group A,no obvious abnormality was found six months after operation.Conclusion The“one-step”laparoscopic lymph node dissection for penile carcinoma via abdominal wall has less intraoperative bleeding,a wide range of lymph node dissection,rapid postoperative recovery,less complications and good tumor control effect.