阴茎癌腹腔镜下腹股沟淋巴结清扫两种不同入路疗效比较

Comparison of the efficacy of laparoscopic inguinal lymph node dissection between the subcutaneous pathway of the lower abdomen and the subcutaneous pathway of the lower limbs in patients with penile cancer

目的探讨不同入路阴茎癌腹腔镜下腹股沟淋巴结清扫的疗效差异。方法回顾性分析2015年6月～2018年6月23例接受腹腔镜下腹股沟淋巴结清扫术的阴茎癌患者临床资料。其中采用下腹部皮下通路术式13例(I组),下肢皮下通路术式10例(Ⅱ组)。对比两组手术时间、淋巴结清扫个数、术中出血量、术后引流量、平均住院时间、引流管留置时间及术中和术后并发症等。结果两组患者手术皆成功,双侧腹股沟淋巴结清扫较为彻底。两组间淋巴结清扫个数、平均住院时间均无统计学差异(P>0.05)。两组间手术时间、术中出血量、引流管留置时间、术后引流量均有统计学差异(P<0.05)。两组患者术后恢复良好,伤口甲级愈合,治疗过程中未见严重并发症,I组术中有1例患者出现单侧大隐静脉损伤,术后2例患者出现腹股沟淋巴结囊肿,经治疗后痊愈;Ⅱ组有1例出现术后淋巴渗漏,及时发现并给予加压包扎,经常规处理后自行好转。术后随访(15±5)个月,无肿瘤复发。结论对于阴茎癌患者采用不同入路进行腹腔镜下腹股沟淋巴结清扫,皆达到治疗目的,术后皆恢复良好,未出现严重并发症。下腹部皮下入路手术时间较短,但下肢皮下入路更容易暴露局部淋巴结,操作难度较低,术中出血量少,安全性高,损伤较小,相对更具有优势。

Objective To discuss the differences of efficacy of laparoscopic inguinal lymph node dissection in different surgery pathways in patients with penile cancer.Methods The data of23patients with penile cancer who received laparoscopic inguinal lymph node dissection from Jun2015to Jun2018were retrospectively analyzed.13cases(group I)were treated with subcutaneous pathway of the lower abdomen while the other10cases(groupⅡ)were conducted with subcutaneous pathway of the lower limb.The differences of operation time,lymph nodes dissection numbers,intraoperative blood loss,postoperative drainage volume,average hospitalization time,catheter indwelling time and postoperative complications between the two groups were compared.Results The operation were successful in both groups and bilateral inguinal lymph nodes were thoroughly dissected.There was no statistically significant difference between the two groups in lymph nodes dissection numbers and average hospitalzation time(P>0.05).The comparison of two groups concerning the operation time,intraoperative blood loss,catheter indwelling time and postoperative drainage volume exhibited significantly statistical difference(P<0.05).Both groups of patients showed an ideal recovery and no serious complication happened during the treatment.Only one patient suffered from unilateral great saphenous vein injury and two patients had inguinal lymph node cyst after surgery in group I,while one patient had postoperative lymphatic leakage in groupⅡ.They were both detected in time and cured after a period of treatment.There were no tumor recurrence after a follow-up time of(15±5)months.Conclusion Both surgery pathways can ideally dissect the inguinal lymph nodes,combined with rapid recovery as well as few complications.Comparing with the subcutaneous pathway of the lower abdomen,another surgery pathway shows its superiorities in exposure to local lymph nodes,low difficulty in operation,less intraoperative blood loss,higher security and less damage.