外阴癌腹腔镜下腹股沟淋巴结清扫术的临床研究

Video-endoscopic inguinal lymphadenectomy in vulvar cancer

目的探讨外阴浸润癌行腹腔镜下腹股沟淋巴结切除术的可行性和手术技巧。方法回顾性分析40例外阴癌患者。其中腹腔镜组行腹腔镜下双侧腹股沟淋巴结清扫术,共20例;开放组行开放性双侧腹股沟淋巴结清扫术,共20例。两组患者均同时行根治性局部外阴切除术。结果所有患者均顺利完成手术,腹腔镜组的手术时间为(311.80±17.71)分钟,长于开放组的(206.90±12.95)分钟(P<0.01)。腹腔镜组淋巴结切除时间长于开放组,分别为(181.00±11.04)分钟和(91.50±5.47)分钟(P<0.01)。淋巴结清扫出血量腹腔镜组少于开放组,分别为(16.25±2.26)m L和(66.75±10.23)m L,但差异无统计学意义(P=0.104)。术中总出血量、左右侧腹股沟淋巴结切除数目两组比较差异均无统计学意义(均P>0.05)。术后住院天数腹腔镜组短于开放组,分别为(15.15±1.04)天和(21.50±2.61)天,而腹股沟区手术相关并发症及淋巴相关并发症腹腔镜组均少于开放组(均P<0.01)。术后观察随访0.5-5年,两组间局部复发率、远处转移率、病死率等差异均无统计学意义(均P>0.05)。结论外阴癌腹腔镜下腹股沟淋巴结清扫术是安全、可行的,能明显减少术后并发症,缩短住院时间,并不增加术后复发的风险。

Objective To study the feasibility and surgical techniques of video-endoscopic inguinal lymphadenectomy（ VEIL） in vulvar cancer. Methods Clinical data of 40 patients with vulvar cancer were retrospectively reviewed.Among 40 patients,20 cases received VEIL（ study group） and another 20 underwent open inguinal lymphadenectomy（ OIL,control group）. Results All patients completed operations successfully. The overall time of surgery was（ 311. 80 ±17. 71） min in study group,which was longer than that in control group [（ 206. 90 ± 12. 95） min,P〈 0. 01） ]. The time of lymphadenectomy was also longer in study group than that in control group [（ 181. 00 ± 11. 04） min vs（ 91. 50 ± 5. 47）min,P〈 0. 01） ]. The blood loss for lymphadenectomy was less in study group than that in control group [（ 16. 25 ± 2. 26）m L vs（ 66. 75 ± 10. 23） m L,P = 0. 104） ]. There were no significant differences in total blood loss and the number of dissected lymph nodes from both inguinal regions between two groups（ P〉 0. 05）. Moreover,the length of hospital stay in study group was shorter than that in control group [（ 15. 15 ± 1. 04） d vs（ 21. 50 ± 2. 61） d]. The operation related complications for inguinal surgery and the lymph node related adverse reactions were less in study group than those in control group（ P〈 0. 01）. During 0. 5- 5 years follow-up,no difference was detected between two groups for local recurrence,metastasis or death（ P〉 0. 05）. Conclusion Video-endoscopic inguinal lymphadenectomy is a feasible and safe procedure in treatment of vulvar cancer. VEIL can reduce postoperative complications and hospitalization days,and does not increase the risk of recurrence.