腔镜下外阴癌腹股沟淋巴结切除术的临床观察

Clinical study on laparoscopic inguinal lymphadenectomy for vulvar carcinoma

目的探讨腔镜下外阴癌腹股沟淋巴结切除术的新方法。方法采用与腔镜下乳腺癌腋窝淋巴结切除术相似的方法,对2例外阴癌腹股沟拟切除淋巴结手术野内的皮下脂肪进行溶脂和吸脂,再插入腔镜并充入CO2气体,以超声刀切除淋巴结。术野放置负压引流并以盐水软袋压迫。结果经溶脂和吸脂后,腹股沟皮下显露出众多的淋巴管、小血管以及其间的淋巴结,淋巴结得以容易切除。2例患者术后患处恢复好,经4个月随访,腹股沟局部和下肢均无淋巴水肿。结论腔镜下外阴癌腹股沟淋巴结切除术能够方便地实施淋巴结切除,从而保存了大部分淋巴管,对术后腹股沟局部和下肢淋巴回流的影响较小,并且避免了腹股沟区常规手术的大切口,值得临床推广。

Objective To explore the new method of inguinal lymphadenectomy to reduce side effects of conventional methods on patients with vulvar carcinoma.Methods Lipolysis and liposuction were performed to subcutaneous fat on inguinal region using the similar methods as laparoscopic axillary lymph node dissection of breast cancer.We inserted laparoscope and filled CO2 gas to this field and then resected inguinal lymph nodes with harmonic scalpel.The operative field was placed with the vacuum sealing drainage and pressured with soft saline bag after operation.Results After lipolysis and liposuction,many lymphatic,small blood vessels and hanging lymph nodes were showed.Lymph nodes could be easily removed.Local derma recovered quickly after the operation.No lymphedema emerged in the inguinal region and lower limbs of the patient after 4-month follow-up.Conclusion Only lymph nodes are removed in laparoscopic inguinal lymphadenectomy and most of the lymphatic vessels are kept.There is less influence on the lymph backflow of inguinal region and lower limbs.Large incision of routine operation is avoided by this procedure.The laparoscopic inguinal lymphadenectomy is worthy to be popularized.