阴茎癌腹腔镜下和开放式腹股沟淋巴结清扫术的对比研究

A retrospective analysis of laparoscopic and open inguinal lymphadenectomy for the treatment of the patients with penis carcinoma

目的 比较阴茎癌腹腔镜下与开放式双侧腹股沟淋巴结清扫术的临床效果. 方法 回顾性分析2007年6月至2011年6月收治的23例阴茎癌患者的临床资料,年龄40～75岁,平均57岁.病程7d～9年,平均18.6个月.术前临床分期T1期10例,T2期7例,T3期6例.10例腹股沟淋巴结肿大,其中3例有2枚肿大淋巴结.根据腹股沟淋巴结清扫方式将患者分为腹腔镜手术（laparoscopic surgery,LS）组10例和开放式手术（open surgery,OS）组13例,两组患者的年龄、病程、肿瘤分期和淋巴结肿大情况等比较差异均无统计学意义（P＞0.05）.比较两组患者的手术时间、术中出血量、术后引流管留置时间、平均住院时间、切除淋巴结数量及并发症等情况. 结果 LS组手术时间（103.6±15.2）min、术中出血量（56.5±6.8）ml、术后引流管留置时间（5.8±0.8）d、住院时间（8.5±1.1）d,OS组手术时间（156.8±18.3） min、术中出血量（88.5±9.5）ml、术后引流管留置时间（12.5±1.3）d、住院时间（15.7±1.9）d,两组比较差异均有统计学意义（P＜0.05）.LS组切除淋巴结数量为（9.5±1.3）枚、OS组为（10.3±1.5）枚；LS组病理阳性淋巴结数量为5处6枚,OS组为5处7枚,两组比较差异均无统计学意义（P＞0.05）.两组均无输血病例,无败血症等严重并发症发生,无死亡病例.随访12～48个月,OS组出现肺转移1例,其余患者无原位复发及转移. 结论 与开放手术比较,阴茎癌腹腔镜下双侧腹股沟淋巴结清扫术具有术中出血量少、术后恢复快、住院时间短、并发症少等优点,是一项安全有效的手术.

Objective To compare the effects of laparoscopic surgery and open surgery of ingui- nal lymphadenectomy in patients with penis carcinoma. Methods A retrospective case-control study was carried out. The retrospective analysis of clinic data of 10 patients with penis carcinoma who had laparoscopic inguinal lymphadenectomy and 13 who had open inguinal lymphadenectomy were collected from June 2007 to June 2011, with an average age of 57 （40--75 years）, and the average follow-up of 18.6 months （7 days to 9 years）. Preoperative clinical stage were T1 in 10 cases, T2 in 7 cases,T1 in 6 cases, with 10 patients detecting inguinal lymph nodes enlargement, while three of which have two enlarged lymph nodes. The age of patients, duration of disease, tumor stage and lymph node enlarge- ment have no statistically significant difference between laparoscopic surgery （LS） group and open surgery （OS） group. The mean operation time,intraoperative blood loss, time of postoperative drain- age, hospitalization duration, mean number of excised lymph nodes and postoperative complications were analyzed. Results The mean operative time,intraoperative blood loss, time of postoperative drainage, and hospitalization duration of LS group and OS group were （103.6＋15.2） min, （56.5 ＋6.8） ml, （5.8＋0.8） d, （8.5＋1.1） d versus （156.8＋18.3） min, （88.5＋9.5） ml, （12.5＋1.3） d, （15.7＋1.9） d, respectively. There was significantly different between the two groups （P〈0.05）. However, the mean number of lymph nodes and the mean number of positive lymph nodes excised were not statistically different between the two groups （P〈0.05）. There was no transfusion, and no severe complications occurred in either group. With the follow-up of 12--48 months,only one case of lung metastasis detected in OS group. Conclusions Compared with the open inguinal lymphadenee- tomy, laparoscopic inguinal lymphadeneetomy is more safe and effective. It leads to less intraoperative blood loss, less hospitalization duration, less postoperative complications and quick postoperative re- covery.