单孔腹腔镜腹股沟淋巴结清扫术在原发性阴道癌中的应用

Application of laparoendoscopic single-site inguinal lymphadenectomy for primary vaginal cancer

目的探讨单孔腹腔镜腹股沟淋巴结清扫术治疗原发性阴道癌的临床疗效和手术策略,为单孔腹腔镜在阴道癌腹股沟淋巴结清扫术中的应用提供经验和参考。方法 2018年6月至7月东南大学附属中大医院妇科对2例原发性阴道癌患者成功实施了单孔腹腔镜腹股沟淋巴结清扫术,对其临床资料和手术策略进行回顾性分析。结果 2例患者共4侧腹股沟淋巴结清扫术均顺利完成,无中转传统多孔腹腔镜和开放手术。单侧平均手术时间45 min(35～55 min),单侧平均术中出血量45 ml(20～85 ml),单侧淋巴结平均清扫数7. 2枚(6～9枚),其中1例患者在一侧腹股沟区检出2枚(12%)阳性淋巴结。术后腹股沟区均采用负压持续引流,引流量平均每日32. 5 ml(2～250 ml),术后8 d均拔除引流管。随访至2018年9月,2例患者均无伤口感染、伤口裂开、皮瓣坏死、下肢水肿、淋巴漏等并发症,未发现肿瘤复发和转移。结论单孔腹腔镜腹股沟淋巴结清扫术治疗原发性阴道癌安全可行,可减少术后并发症。

Objective To investigate the clinical feasibility and surgical strategies of laparoendoscopic single- site inguinal lymphadenectomy（LESS- IL）in the treatment of primary vaginal cancer, and to provide some experience and reference for its application of vaginal cancer. Methods We retrospectively analyzed clinical data and surgical strategies of two patients with primary vaginal cancer who were successfully implemented LESS- IL in the Department of Gynecology, Zhongda Hospital Affiliated to Southeast University from Jun.to Jul. 2018. Results LESS- IL was successfully completed in total four sides of two patients, no case was conversion to conventional laparoscopic or open surgery. The mean operation time and intraoperative blood loss of each side was 45 min（35／｜55 min） and 45 ml （20／｜85 ml） respectively. The mean numbers of lymph nodes removed was 7.2 （6／｜9） in each side, and two （12%） positive lymph nodes were detected in one patient′s groin area. Both two cases were treated with sufficient drainage and the mean daily drainage volume was 32.5 ml（2／｜250 ml）, while the drainage tube was all removed in the eighth postoperative day. Till now, no complications like incision infection, incision splitting, skin necrosis and lymphedema were observed in two cases, neither tumor recurrence and metastasis. Conclusions LESS- IL for treating primary vaginal cancer is safe and feasible, which could diminish postoperative complications.