膜性层面分离法在改良根治腹股沟淋巴清扫术中的运用

Surgical technical dissection of membranous layer(Camper's fascia)in modified radical inguinal lymphadenectomy

目的：评价运用膜性层面（Camper筋膜浅深层之间）分离法在改良根治腹股沟淋巴清扫术中的控瘤效果和并发症。方法：回顾性分析2008年1月~2013年12月间35例阴茎鳞状细胞癌患者的临床资料：患者年龄30~70岁,中位年龄50岁。以Catalona的改良腹股沟淋巴切除为模板,运用膜性层面的分离方法整块剔除双侧阔筋膜上浅组和筛筋膜下股血管前面和内侧深组淋巴脂肪组织。保留阔筋膜和大隐静脉且未行缝匠肌转位。双侧同期清扫20例,分期15例。随访8~69个月,中位随访37个月。追踪患者生存及并发症。结果：35例清除淋巴结总数753枚,平均每人每侧10.8枚。阳性患者80%（28/35）,其中单侧阳性85.7%（24/28）,双侧阳性14.3%（4/28）。3年总的疾病特异性生存率为95.2%,其中pN0、pN1、pN2均为100%,pN3为75%。保留阴茎局部复发9.5%（2/21）。腹股沟区总并发症23%（8/35）,包含切口感染5.7%（2/35）,下肢及阴囊淋巴肿8.6%（3/35）,局部复发8.6%（3/35）;未发生皮瓣坏死及植皮;无下肢静脉血栓。结论：膜性层面分离法疗效与经典根治术相似,并发症明显降低。

Objective： To evaluate oncological outcomes and postoperative complications of dissection of mem- branous layer （between the superficial and deep stratum of Camper＇s fascia） in modified radical inguinal lymphade- nectomy. Method： Thirty-five patients with penile squamous cell carcinoma were treated with modified radical in- guinal lymphadenectomy from January 2008 to December 2013 in our institute. Patients＇ age was 30-70 years old, with a median of 50 years. The records of groin dissection on 35 patients were retrospectively analyzed. We uti- lized this template of modified inguinal lymphadenectomy through the work of Catalona. The superficial lymphatic tissue overlying the fascia lata with the en bloc specimen was swept, and underlying the cribriform fascia deep in- guinal lymph node packet that is located primarily anterior and medial to the femoral artery were removed. The fascia lata and greater saphenous vein were left in place, and no transposition was done in sartorius muscle. The follow-up period ranged from eight to 69 months, with a median of 37 months. The survival probabilities and mor- bidity of complications were calculated. Result： The total nodes of inguinal lymphadenectomy in all 35 patients was 753, average 10.8 nodes unilateral per patient. The positive rate was 80 % （28/35） including 85.7 % （24/28） uni- lateral and 14.3%（4/28） bilateral. The average 3-year disease-free survival rate was 95.2% （100% for pN0, pN1 , pN2 and 75 % for pN3 ）. Local recurrence after penile conserving surgery was 9.5 % （2/21）. The overall incidence of complication of inguinal region was 23% （8/35）, including wound infection 5.7% （2/35）, lower extremity and scrotum lymphedema 8.6 % （3/35） and local recurrence 8.6 ~ （3/35）. No skin grafting owing to necrosis or deep vein thrombosis was found. Conclusion： A technique of separating membranous layer （Camper＇s fascia） in the sub- cutaneum provides therapeutic effects similar to traditional radical lymphadenectomy, and this surgical procedure obviously reduce the incidence of complication.