传统皮桥法、改良皮桥法与腹腔镜法在阴茎癌腹股沟淋巴结清扫中的对比

Comparison of Traditional Skin Bridge Technique,Modified Skin Bridge Methodand Laparoscopic Dissection of Inguinal Lymph Nodes in Penile Cancer

目的 探讨传统皮桥法与改良皮桥法,腹腔镜清扫术在阴茎癌腹股沟淋巴结清扫应用、手术效果及并发症。方法 回顾性分析2011年1月至2019年12月于锦州医科大学附属第一医院确诊为阴茎癌并行腹股沟淋巴结清扫。收集分别行传统皮桥法腹股沟淋巴结清扫、改良皮桥法清扫、腹腔镜腹股沟淋巴结清扫的40例患者的临床资料,并完成了为期最少9个月的随访。对3组病人的人口学特征(年龄、体重指数、是否吸烟、是否患有糖尿病)和手术及术后效果(手术时间、术中估计出血量、术后留置引流时间、单侧淋巴结清扫个数、术后并发症发生率、术后住院天数)进行对比。结果 3组患者之间人口学特征差异无统计学意义。3组患者之间的手术时间[(151.00±25.45)min vs(121.79±24.34)min vs(186.25±32.18)min,(P<0.001)],术中估计出血量[(57.9±6.83)mL vs(58.43±10.09)mL vs(29.75±11.11)mL,(P<0.001)],术后留置引流时间[(9.8±2.66)d vs(9.43±1.91)d vs(5.06±1.87)d,(P<0.001)],术后住院天数[(12.0±1.94)d vs(10.71±1.86)d vs(8.69±2.12)d,(P<0.001)]差异有统计学性意义。皮桥组与腹腔镜组术后并发症发生率(45.83%vs 12.5%,P<0.001)差异有统计学意义。3组患者之间的单侧淋巴结清扫数[(10.0±1.56)vs(10.79±0.97)vs(10.56±1.63),(P=0.406)]差异无统计学意义。结论 腹腔镜腹股沟淋巴结清扫在控瘤方面与传统皮桥法及改良皮桥法腹股沟淋巴结清扫相似。腹腔镜组术后并发症发生率低,术后康复快,但手术时间相对较长。改良皮桥法手术时间较传统皮桥法缩短,可考虑用于不适合腹腔镜患者。

Objective To investigate the application,perioperative outcome and complications of laparoscopic,traditional and modified groin skin bridge technique and dissection for inguinal lymph node dissection for penile cancer.Methods The patients were diagnosed with penile cancer and performed inguinal lymph node dissection in the First Affiliated Hospital of Jinzhou Medical University from January 2011 to December 2019.Clinical data of 40 patients who underwent the traditional skin bridge method,modified skin bridge method,and laparoscopic inguinal lymph node dissection were collected and at least 9 months of follow up was completed.The demographic characteristics of the three groups of patients,including age,body mass index,whether they smoke,and whether they have diabetes and the operative and postoperative effects of the three groups,including operative time,estimated intraoperative blood loss,postoperative indentation and drainage time,number of unilateral lymph node dissection,incidence of postoperative complications,and postoperative length of stay,were compared.Results There was no statistically significant difference in demographic characteristics among the three groups.The operative time between the three groups[(151.00±25.45)min vs(121.79±24.34)min vs(186.25±32.18)min,(P<0.001)],the estimated intraoperative blood loss[(57.9±6.83)mL vs(58.43±10.09)mL vs(29.75±11.11)mL,(P<0.001)],and the postoperative drainage time[(9.8±2.66)d vs(9.43±1.91)d vs(5.06±1.87)d,(P<0.001)]and postoperative hospitalization days[(12.0±1.94)d vs(10.71±1.86)d vs(8.69±2.12)d,(P<0.001)]were statistically significantly different.The postoperative complication rate was statistically significantly different between the bridge group and the laparoscopic group(45.83%vs 12.5%,P<0.001).There was no statistically significant difference in the number of unilateral lymph node dissections between the three groups[(10.0±1.56)vs(10.79±0.97)vs(10.56±1.63),(P=0.406)].Conclusion Laparoscopic inguinal lymph node dissection was similar to the traditional and improved method of groin bridge in tumor control.In the laparoscopic group,the incidence of postoperative complications was low and postoperative recovery was fast,while the operation time was relatively long.Compared with the traditional groin skin bridge technique,the modified method can shorten the operation time,so it can be considered for patients not suitable for laparoscopy.