腹腔镜下预防性腹股沟淋巴结清扫术治疗阴茎癌患者8例报道

Laparoscopic prophylactic inguinal lymph node dissection forthe treatment ofpatients with penile cancer：8 cases report

目的：讨论预防性腹腔镜腹股沟淋巴结清扫术治疗阴茎癌的临床疗效。方法回顾性分析8例（16侧）接受腹腔镜下预防性腹股沟淋巴结清扫术患者的临床资料。依据股三角体表标志建立3个Trocar，从股三角尖端向头侧分离皮瓣，清扫边界上至腹股沟韧带、下至股三角尖端、内侧界为长收肌内侧，外侧界至缝匠肌外缘，清扫界限内的腹股沟浅深组淋巴结群。结果8例（16侧）腹腔镜下预防性腹股沟淋巴结清扫术均顺利完成，清扫手术时间平均每侧（103±18.4）min（8例患者按16侧计算），出血量平均（48.5±7.5）mL，清扫淋巴结数目平均每侧（8.8±1.8）枚，总计141枚淋巴结，其中2例患者各自在一侧中发现1枚阳性淋巴结。术后1例（1侧）切口蜂窝织炎，2例（共计2侧）下肢水肿。随访时间为9-33个月，平均（24±10.5）月，所有患者腹股沟区无肿瘤复发和转移。结论腹腔镜下预防性腹股沟淋巴结清扫术是一种针对阴茎癌腹股沟淋巴结安全、有效的治疗手段，且术后并发症少，皮瓣坏死低。

Objective To investigate the clinical effect of Laparoscopic prophylactic inguinal lymph node dissection in the treatment ofpatients with penile cancer. Methods The clinical data collected from 8 cases with penile cancer who underwent bilateral prophylactic inguinal lymph node dissectionwere retrospectively analyzed. In the 8 cases, three trocars were established according to trigonum femorale, the skin flap was separated from trigonum femorale tip toward top, and lastly dissected were the shallow and deep lymph nodes confined to the anatomic space bordered by the inguinal ligament superiorly, the trigonum femorale tip inferiorly , the adductor longus medial margin medially, the Sartorius lateral margin laterally. Results Laparoscopic prophylactic inguinal lymph node dissections for 8 patients were operated successfully , the mean operation time was 103±18.4min/lateral, the average number of dissected lymph nodes was 8.8±1.8/lateral , amount to 141, and 2 of them were pathologically positive. Postoperative complications included surgical site cellulitis（one case） and edema of lower extremity（2 cases）. The 8 patients were followed up for 9 to 33 months, averaged to 24±10.5months. No patient had tumor recurrence and metastasis in inguinal region. Conclusion Laparoscopic prophylactic inguinal lymph node dissection is a safe and efficient method for the treatment of penile cancer It has an advantage of few complications and skin flap necroses.