顺行机器人辅助腹腔镜下阴茎癌腹股沟淋巴结清扫术的临床研究

Robot-assisted laparoscopic antegrade inguinal lymphadenectomy for penile cancer patients: clinical report of 10 cases

目的 探讨顺行机器人辅助腹腔镜下阴茎癌腹股沟淋巴结清扫术的疗效及安全性。方法 回顾性分析2019年3月至2020年1月陆军军医大学第一附属医院泌尿外科收治的10例接受双侧腹股沟淋巴结清扫术的阴茎癌患者的临床资料。10例患者术前病理证实为阴茎鳞状细胞癌,在全身麻醉下行机器人辅助腹腔镜下双侧腹股沟淋巴结清扫术。结果 10例阴茎癌患者均在全身麻醉下顺利完成双侧腹股沟淋巴结清扫术,术中均未中转开腹,手术时间为80~119(87.90±11.58)min;术中出血量为5~25(12.50±8.90)mL;清除淋巴结数量为10~35(22.90±8.90)枚,阳性淋巴结(1例T2期6枚,1例T2期3枚,1例T1期3枚,1例T1期2枚);术后住院时间为2~5(2.80±1.23)d;引流管留置时间为7~27(17.10±3.63)d。患者均未发生皮肤坏死、出血、淋巴瘘、感染等并发症。术后随访时间为14~24(16.40±6.79)个月。1例发生复发转移,其余9例未发生复发和转移。结论 机器人辅助腹腔镜下双侧腹股沟淋巴结清扫术为一种安全有效的阴茎癌临床方法,能减少并发症,促进患者术后快速恢复。

Objective To investigate the efficacy and safety of robot-assisted laparoscopic antegrade inguinal lymph node dissection for patients with penile cancer. Methods A retrospective study was performed on clinical data from 10 patients with penile cancer admitted to the First Affiliated Hospital of Army Medical University from March 2019 to January 2020. All of them were diagnosed with penis squamous cell carcinoma by pathological diagnosis. Robot-assisted laparoscopic antegrade inguinal lymphadenectomy was performed for all patients under general anesthesia. Results The surgery was successfully accomplished at totally 20 sides without intraoperative conversion to open surgery. The operation time was 87.90±11.58(80~119) min, intraoperative blood loss was 12.50±8.90(5~25) mL, and number of removed lymph nodes was 22.90±8.90(10~35). The positive lymph nodes were 6 in 1 case at T2 stage, 3 in 1 case at T2 stage, 3 in 1 case at T1 stage and 2 in 1 case at T1 stage. The postoperative hospital stay was 2.80±1.23(2~5) d, and the indwelling time of drainage tube was 17.10±3.63(7~27) d. None of the patients experienced skin necrosis, bleeding, lymphatic fistula, infection and other complications. During the follow-up time of 16.40±6.79(14~24) months, recurrence and metastasis were found in only 1 case, and not in the other 9 cases. Conclusion Robot-assisted laparoscopic antegrade bilateral inguinal lymphadenectomy is a safe and effective dissection for penile cancer, which can reduce complications and promote rapid recovery after surgery.