三孔法腹腔镜下顺行经腹皮下入路腹股沟淋巴结清扫术治疗阴茎癌20例报告

Three-hole laparoscopic antegrade hypogastric subcutaneous approach inguinal lymph node dissection for 20 patients with penile carcinoma

目的探讨阴茎癌患者行三孔法腹腔镜下顺行经腹皮下入路腹股沟淋巴结清扫术可行性及优势。方法回顾性分析2019年3月至2021年7月于中国科学技术大学附属第一医院行三孔法腹腔镜下顺行经腹皮下入路腹股沟淋巴结清扫术的阴茎癌患者病例资料。于脐下1 cm处切开皮肤及皮下,人工自制球囊建立皮下空间,在双侧腹直肌旁分别置入双侧12 mm套管,脐下置入10 mm套管作腔镜观察孔;在腹壁前方脂肪层下向右侧腹股沟区游离,寻及腹股沟韧带和浅筋膜、深筋膜;以此为标志,游离腹股沟区浅、深淋巴结。同法处理左侧腹股沟区。结果20例患者均顺利完成手术,手术时间(122±22)min(不包括阴茎部分切时间),手术中出血量(49±7)ml,术后住院时间为(7.3±2.0)d,术后引流管拔除时间(7.9±1.3)d。左侧清扫淋巴结数量11.5(5~21)枚,右侧清扫淋巴结10(2~19)枚。20例患者术后随访3~28个月,2例患者术后淋巴漏液严重予以加强营养、延长拔管时间,其余患者随访过程中均无原发灶、腹股沟及盆腔淋巴结复发、转移及严重不良并发症发生。结论三孔法腹腔镜下顺行经腹皮下入路腹股沟淋巴结清扫术能达到预期手术疗效,术中及术后并发症少,术后恢复快,是一种安全有效的微创治疗手段,值得临床推广。

Objective To explore the feasibility and advantages of three hole laparoscopic antegrade hypogastric subcutaneous approach inguinal lymph node dissection in patients with penile cancer.Methods The data of patients with penile cancer who underwent three-hole laparoscopic antegrade hypogastric subcutaneous approach inguinal lymph node dissection in the First Affiliated Hospital of University of Science and Technology of China from March 2019 to July 2021 were analyzed retrospectively.The skin and subcutaneous area were cut 1cm below the umbilicus,and the subcutaneous space was established with a self-made balloon.A 12 cm trocar and a 5 cm trocar were inserted into the McBurney's point and the inverse McBurney's point,respectively,and a 10 cm trocar was inserted into the infra-umbilical for endoscopic observation.The inguinal ligament,superficial fascia and deep fascia were searched under the fat layer in front of the abdominal wall.Marked by these anatomical structures,shallow and deep inguinal lymph nodes were isolated.The same procedure was performed on the left inguinal area.Results All the 20 patients were completed the operations successfully,the operation time was(122±22)min(excluding the partial penis resection time),the amount of blood loss was(49±7)ml,the postoperative hospital stay was(7.3±2.0)days,and the postoperative drainage tube removal time was(7.9±1.3)days.The number of left dissected lymph nodes was 11.5(5-21),and the number of right dissected lymph nodes was 10(2-19).Twenty patients were followed up for 3 to 28 months.Two patients had serious lymphatic leakage after operations,which improved after symptomatic treatment with enhanced nutrition and prolonged the retention of drainage tube removed.No recurrence,metastasis or serious adverse complications occurred in the other patients during follow-up.Conclusion Three hole laparoscopic antegrade hypogastric subcutaneous approach inguinal lymph node dissection is a safe and effective minimally invasive treatment,which is worthy of clinical application.