腹腔镜下腹股沟淋巴清扫术在外阴癌中的应用技巧及可行性

Laparoscopic inguinal lymphadenectomy: a new minimally invasive technique to treat vulva cancer

目的探讨外阴癌患者行腹腔镜下腹股沟淋巴清扫术的手术技巧和可行性。方法2008年8月至2010年5月，对重庆市第三军医大学第一附属医院收治的14例外阴浸润癌患者行腹腔镜下双侧腹股沟淋巴清扫术，观察治疗效果。结果14例患者均顺利完成腹腔镜下双侧腹股沟淋巴清扫术，手术时间平均105min（75—120min），术中出血平均85mL（20～130mL），每侧腹股沟切除淋巴结数平均为5．8个（3～13个），术后住院平均10．4d。所有患者均未发生腹股沟区皮肤坏死。有3例患者4侧腹股沟区发生淋巴囊肿，持续2～4个月自行消失。2例患者3例腹股沟区术后出现腹股沟区皮下感染，经保守治疗痊愈。结论外阴癌患者施行腹腔镜下腹股沟淋巴清扫术安全可行，可有效降低术后并发症，是微创治疗外阴癌的一个有效方法，但其远期疗效有待进一步研究。

Objective Investigate technique and skill of laparoscopic excision of inguinal lymph nodes for vulvar cancer. Methods 14 cases with vulvar cancer underwent bilateral laparoscopic excision of inguinal lymph nodes between August 2008 and May 2010. Results All patients accepted bilateral laparoscopie inguinal lymphadenectomy successfully. The median operative time was 105min（75 - 120min） , the average bleed was 85mL（20 - 130mL） , and the mean number of nodes removed unilateral was 5.8 （range 3 - 13 ）. No perioperative complications occurred. The average postoperative stay was 10. 4d. No skin necrosis and wound infection was seen in inguinal region in any cases. 4 lymphocele happened in 3 cases with spontaneous regression 2 to 4 months after lympbadenectomy. Cellulitis happened in inguinal region in 2 cases. Conclusion The laparoscopic excision of inguinal lymph nodes for vulvar cancer is a safe and feasible technique that appears to diminish the wound-related complications associated with the standard open approach. But its long curative effect still to be researched.