腹股沟皮桥在阴茎癌髂腹股沟淋巴结清扫中的应用

Application of groin skin bridge in ilio-inguinal lymphadenectomy for penile cancer

目的探讨腹股沟皮桥在阴茎癌髂腹股沟淋巴结清扫术中的应用。方法2007年5月至2008年7月,对12例阴茎鳞状细胞癌患者行双侧髂腹股沟淋巴结清扫术,手术取腹股沟韧带上下方两个平行的横行切口,游离两切口间的皮瓣,形成腹股沟皮桥。经上方切口行髂淋巴结清扫后,于腹股沟皮桥下整块切除腹股沟浅、深组淋巴结,并保留大隐静脉。结果12例患者中,无一例发生切口皮缘的缺血、坏死或感染。10例(83.33%)的4个切口均Ⅰ期愈合,余2例各有1个切口因淋巴渗液而延期愈合。3例(25.00%)轻微双下肢水肿。随访中4例(33.33%)出现不同程度的阴茎、阴囊水肿,包括2例下肢水肿者。结论腹股沟皮桥技术有助于保护腹股沟区皮瓣的血供,能显著减少甚至避免皮缘缺血、坏死的发生。

Objective To study groin skin bridge technique and its advantages in ilio-inguinal lymphadenectomy for penile cancer. Methods From May 2007 to July 2008,12 patients with penile squamous cell carcinoma underwent bilateral ilio-inguinal lymphadenectomy. Double inguinal incisions parallel to inguinal ligament were used for each side, one incision was 3 cm superior and another was 4-5 cm inferior to the ligament. Skin flap between these two incisions was fashioned to form groin skin bridge. Pelvic lymph nodes were dissected through the superior incision,and then the su perficial and deep groups of inguinal lymph nodes were removed en bloc under the groin skin bridge with saphenous vein preserved. Results In these 12 patients, there was no ischemia, necrosis of flap margin occurred,and also no wound infection found. Ten of them （83. 33%） had their 4 inci sional wounds healing in time without any problems. Another two experienced the delayed healing of one incision because of lymphatic leakage. Edema of lower extremity was observed in 3 patients （25.00%）,and scrotal edema occurred in 4 patients（33. 33%）. Conclusions The technique of groin skin bridge could provide better preservation of anastomotie vessels in the superficial fatty layer of Camper＇s fascia, therefore protect the viability of skin flap in ilio-inguinal lymphadenectomy.