外阴癌腹腔镜腹股沟淋巴结切除术中体表标识的导航作用

Navigation of Body Surface Markers during Laparoscopic Inguinal Lymphadenectomy for Vulvar Cancer

目的探讨体表标识导航下行外阴癌腹腔镜腹股沟淋巴结切除的安全性和有效性。方法回顾性分析2015年3月2019年10月在我院行腹腔镜腹股沟淋巴结切除术(video endoscopic inguinal lymphadenectomy,VEIL)的12例外阴癌患者的临床资料,消毒铺巾前先行腹股沟手术区域标识:标记手术套管穿刺孔、腹股沟手术区域的边界,勾画出腹股沟区三条线(腹直肌外侧缘、髂前上棘水平线、腹股沟韧带)和股三角区三条线(长收肌外侧缘、缝匠肌内侧缘、腹股沟韧带),标记手术区域内重要解剖结构的体表投影(髂前上棘、耻骨结节、隐静脉裂孔)。按经腹壁入路常规、经脐轮下缘置入腹腔镜,在下腹部建立另外两个操作孔道,通过助手按压体表标识的导航作用确定镜下腹股沟区和股三角区淋巴结切除范围,用超声刀切除腹股沟浅淋巴结,再通过按压隐静脉裂孔体表投影标识的导航作用打开卵圆窝,切开股动脉和股静脉鞘,切除腹股沟深淋巴结(股淋巴结)。结果12例患者手术均获得成功,均未中转开放手术,无空气栓塞和大血管损伤等严重手术并发症发生。共切除21侧腹股沟淋巴结,单侧淋巴结切除平均时间(68.69±31.19)min,平均出血量(16.25±12.93)ml,淋巴结切除平均数目为(7.83±1.25)枚。本组术后均在腹股沟手术区域放置血浆引流管,外接负压引流装置,术区无菌纱布覆盖固定。术后引流管平均留置时间为(4.75±1.22)d。12例患者术后石蜡病检结果示手术切缘均为阴性,淋巴结转移率为16.67%(2/12)。术后平均随访(33.75±17.85)个月,腹股沟切口均一期愈合,腹股沟切口并发症率为14.29%(3/21),其中腹股沟淋巴囊肿、积血和下肢水肿各1例。结论在体表标识的导航下行外阴癌VEIL简单易行,安全可靠,疗效确切。

Objective To explore the safety and effectiveness of laparoscopic inguinal lymphadenectomy for vulvar cancer under the guidance of body surface markers.Methods A total of 12 vulvar cancer patients underwent video endoscopic inguinal lymphadenectomy(VEIL)from March 2015 to October 2019 in our hospital were studied.Identified the groin surgery area with a scribing pen before disinfecting the skin:the surgical cannula puncture hole and the boundary of the inguinal region was marked,and the three lines of the inguinal region(the lateral edge of the rectus abdominis,the horizontal line of anterior superior iliac spine and the inguinal ligament)and the three lines of the femoral triangle(the lateral margin of adductor longus,the medial margin of sartorius muscle and the inguinal ligament)was outlined,and the surface projection of the important anatomical structures in the surgical area(the anterior superior iliac spine,the pubic nodules and the saphenous vein hiatus)was marked.Laparoscopy was placed to form subcutaneous air cavity,and two other operation channels were established in the lower abdomen,then lymph node resection was performed.The dissected range of lower inguinal and femoral triangle was determined by the navigation body surface markers,and the superficial inguinal lymph nodes were removed by ultrasonic knife.The oval fossa was opened by pressing the projection mark on the surface of the saphenous vein,and the femoral artery and the sheath of the femoral vein were cut,and the deep inguinal lymph nodes(femoral lymph nodes)were removed.Results All 12 cases(21 laterals)were accomplished the surgery successfully without conversion to open surgery and serious complication.The average operative time was(68.69±31.19)minutes,the average blood loss volume was(16.25±12.93)ml,the average number of resected nodes was(7.83±1.25)in single lateral.The time of indwelling drainage tube was(4.75±1.22)days averagely.The pathologic outcome showed the surgical margin was negative in all 12 cases.All cases were followed up for(33.75±17.85)months averagely.All incisions healed in first stage,and the complication rate of groin incision was 14.29%(3/21).Conclusion VEIL is simple,safe,reliable and effective for vulvar cancer under the navigation of body surface markers.