改良技术减少阴茎癌根治性腹股沟淋巴结清扫术后皮瓣坏死的效果分析

Modified technique of radical inguinal lymphadenectomy to reduce the complication of skin necrosis for penile carcinoma

目的探讨改良技术减少阴茎癌根治性腹股沟淋巴结清扫术后皮瓣坏死的方法与疗效。方法回顾性分析2002年6月至2010年6月63例阴茎癌126侧改良根治性腹股沟淋巴结清扫术患者资料，清扫范围按照经典的根治性腹股沟淋巴结清扫术方法，减少皮瓣坏死改良技术包括：S形切口，在膜性解剖标志引导下精确分离皮瓣层面。结果63例随访12～93个月，共发生并发症37侧次，其中轻度皮瓣坏死7侧次（5．6％），切口感染3侧次（2．4％），淋巴水肿19侧次（15．1％），血清肿2侧次（1．6％），淋巴囊肿5侧次（4．0％），下肢深静脉血栓形成1侧次（0．8％）。未发生并发症106侧（84．1％），发生1次或2次轻度并发症20侧次（16．0％）。结论改良根治腹股沟性淋巴结清扫术中采用S形切口和膜性解剖标志精确分离皮瓣层面技术，可减少术后皮瓣坏死发生率。

Objective To report a modified radical inguinal lymphadenectomy the aim of which is to reduce the incidence of the complication of skin necrosis. Methods One hundred and twenty-six modified radical inguinal dissections were performed in 63 patients with penile carcinoma from June 2002 to June 2010. A modified radical inguinal dissection characterized by an S-shaped incision and precisely separating layers using an anatomical mark was performed. The boundaries of dissection were the same as classic radical inguinal lymphadenectomy. The incidences of complications of skin flap necrosis were retrospectively analyzed. Results The follow-up time ranged from 12 to 93 months. A total of 37 complications occurred, including 7 minimal skin necroses （5.6%） , 3 wound infections （2.4%） , 19 lymphedemas （15.1%） , 2 seroma formations （1.6%） , 5 lymphocele （4.0%） , and 1 deep venous thrombosis （0.8%）. There were no complications in 106 dissections （84. 1% ）, and 20 dissections had one or two minor complications （ 15.9% ）. Conclusions The complication of skin necrosis related to groin dissection in patients with penile carcinoma could be reduced by using this modified inguinal dissection technique, which characterized by an S-shaped incision and precisely separating layers with using an anatomical landmark.