缝匠肌腱膜移位联合保留大隐静脉及其属支在外阴癌根治术中应用

Clinical application of sartorius muscle aponeurosis transposition in radical vulvectomy of vulva carcinoma

目的改良外阴癌根治术腹股沟淋巴结清除过程中,通常将缝匠肌移位缝合于腹股沟韧带上面以覆盖保护股血管,但此法损伤大,并发症多。本研究比较在外阴癌根治术行腹股沟淋巴结清除过程中用缝匠肌腱膜移位代替缝匠肌移位的方法的临床效果。方法回顾性分析郑州大学附属肿瘤医院2009-02-05-2013-06-03收治的48例外阴癌患者临床资料,其中23例行改良外阴广泛切除+腹股沟淋巴结清除术,术中保留大隐静脉(对照组),25例在改良外阴广泛切除+腹股沟淋巴结清除术基础上行缝匠肌腱膜移位代替缝匠肌移位的方法,同时保留大隐静脉及其属支(观察组),就两组患者在手术时间、出血量、术后恢复情况、术后并发症和术后生活质量KPS评分等进行分析。结果对照组和观察组手术时间分别为(136.3±15.1)和(138.0±15.7)min(t=-0.381,P=0.699),术中出血量分别为(130.8±39.4)和(112.4±37.2)mL(t=1.664,P=0.102),差异均无统计学意义。观察组术后Ⅰ期愈合率比对照组有所提高,但差异无统计学意义,χ2=3.520,P=0.061;观察组平均住院天数显著减少,t=2.447,P=0.019。两组感觉异常及活动障碍等术后并发症差异无统计学意义,但观察组患者术后下肢水肿发生率显著下降(χ2=4.691,P=0.030),术后KPS评分提示观察组患者生活质量显著提高,χ2=6.027,P=0.014。结论缝匠肌腱膜移位联合保留大隐静脉的方法可以减少外阴癌患者术后住院时间及部分术后并发症的发生率,明显提高患者术后生活质量,值得临床推广。

OBJECTIVE In the process of radical vulvectomy and bilateral inguinal lymphadenectomy for vulva carcinoma,sartorius transposition procedure can cause unnecessary damage to the skeleton muscle and more complications.This paper aimed to investigate the clinical effect of sartorius muscle aponeurosis transposition instead of sartorius muscle transposition in the radical vulvectomy and bilateral inguinal lymphadenectomy of vulva carcinoma patients.METHODS A total of48 patients who had received radical vulvectomy and bilateral inguinal lymphadenectomy were retrospectively reviewed from February 5 th,2009 to June 3 rd,2013 in Affiliated Tumor Hospital of Zhengzhou University,23 of which received modified radical vulvectomy and inguinal lymphadenectomy with the preservation of saphenous vein and its branches.The other 25 patients（observation group）received the same procedures except sartorius tendon transposition was used instead cutting and transposing the sartorius muscle during bilateral inguinal lymphadenectomy.The operating time,blood loss,recovery time,complications,recurrent rate and postoperative life quality were compared and analyzed.RESULTS The operating time and blood loss at control group were（136.3±15.1）min and（130.8±39.4）mL,at observation group were（138.0±15.7）min and（112.4±37.2）mL and no significant difference was found（P=0.699,0.102）.Ⅰ phase wound healing increased at observation group with no significant difference（χ2=3.520,P=0.061）,however the average hospital stay at observation group was significantly reduced（t=2.447,P=0.019）.Although no significance was found at the incidence of sensory abnormalities and activity dysfunction,lower extremity edema was significantly decreased（χ2=4.691,P=0.030）.Postoperative KPS score showed the quality of life of patients increased significantly（χ2=6.027,P=0.014）.CONCLUSIONS Combined the preservation,saphenous vein and its tributaries,sartorius tendon instead of sartorius transposition during bilateral inguinal lymphadenectomy of radic al vulvectomy could shorten the average hospital stay,reduce some of the postoperative complications,and improve life quality without compromising the outcomes,which is worthy of clinical promotion.