改良内镜下腹股沟淋巴结清扫术:附6例报告

Modified video endoscopic inguinal lymphadenectomy: report of 6 cases

目的报道改良内镜下腹股沟淋巴结清扫技术（VEIL），并探讨其安全性、有效性，以及内镜下腹股沟淋巴结清扫术在阴茎癌患者诊疗的意义。方法对本中心2010年4月至2010年7月3名有腹股沟淋巴结清扫指征的阴茎癌患者行双侧改良内镜下腹股沟淋巴结清扫术。总结手术步骤，统计手术相关数据，结合以往研究进行分析。结果3名患者共6例改良内镜下腹股沟淋巴结清扫术均成功完成，无一例中转开放。手术平均时间106．7min（82～121）。每侧清扫淋巴结平均9．3个（7～11个），无术中并发症发生，除一位患者发生双侧淋巴漏外无皮瓣坏死、淋巴水肿、伤口感染等手术相关并发症。结论改良内镜下腹股沟淋巴结清扫术安全、可行，具备以往内镜下腹股沟淋巴结清扫术低并发症发生率的优势，在保证了清扫范围的同时降低了手术难度，减少了手术时间。该术式对于肿瘤的远期治疗效果仍需进一步验证。

Objective To describe and illustrate a modified approach of video endoscopic inguinal lymphadenectomy （VEIL） to treat penile cancer, and investigate the indication of VEIL for penile carcinoma. Methods Six limbs of 3 patients dated from April 2010 to July 2010 underwent VEIL with a modified approach. Data of the surgery were recorded and analyzed by comparing with the data of the other centers. Results Six modified VEILs were performed in 3 patients without intraoperative complication. One patient had an immediate lymphadenectomy while the other two had a delayed lymphadenectomy. Mean operative time was 106.7 min per groin （range 82-121 min）. The mean number of lymph nodes harvest was 9.3 （ranged 7 to 11）. No operation related complication such as lymphedema, seroma,flap necrosis,wound infection except that one patient suffered from lymphorrhea. Conclusions Modified video endoscopic inguinal lymphadenectomy is applicable. It provides similar therapeutic benefit and less morbidity comparing to traditional VEIL with less operating time. Follow-up is still inadequate to truly judge oncologic efficacy.