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目的:将阴茎癌腹股沟淋巴结清扫手术进行改良,以期降低术后并发症的发生率及其严重程度。方法:2000～2008年对25例阴茎癌患者施行改良根治性腹股沟淋巴结清扫术。清扫范围包括腹股沟浅组和深组淋巴结,清除区域内Scarper’s筋膜下脂肪及纤维组织,不切断大隐静脉主干,旋转带精索的睾丸及鞘膜覆盖股管,而不离断和转移缝匠肌。结果:两侧腹股沟区淋巴结共检出432枚,平均17.3枚,病理证实阳性共17例29枚淋巴结,68%的患者淋巴结转移。术后1例患者出现高热、切口感染、皮缘坏死及远期并发症,另有16%的单侧腹股沟区域出现局部并发症,包括皮缘轻度坏死及愈合延迟、阴囊水肿、淋巴漏。无一例出现严重的大片皮肤坏死、股血管损伤、淋巴管瘤、下肢运动障碍等严重的并发症。五年无进展生存率和总生存率分别为72%和76%。结论:改良根治性腹股沟淋巴结清扫手术保证根治性清扫范围的同时,减少了手术并发症。
Objective: To improve the operation of inguinal lymph node dissection in penile cancer in order to reduce the incidence of postoperative complications and its severity. Methods: From 2000 to 2008, 25 patients with penile cancer underwent modified radical inguinal lymph node dissection. The range of dissection included shallow inguinal and deep lymph nodes, removal of Scarper’s subfascial fat and fibrous tissue within the area, disconnection of the main saphenous vein, rotation of testis with spermatic cord and sheath sheath without interruption and transfer of sartorius muscle. Results: A total of 432 lymph nodes were detected on both sides of the inguinal region, with an average of 17.3. There were 17 lymph nodes in 17 cases and 68% of patients with lymph node metastasis. One patient developed postoperative fever, incision infection, necrosis and long-term skin necrosis complications, and another 16% unilateral groin area of the local complications, including mild necrosis and delayed healing, scrotal edema, lymph leak. No serious case of serious skin necrosis, femoral vascular injury, lymphangioma, dyskinesia and other serious complications. Five-year progression-free survival and overall survival were 72% and 76% respectively. Conclusion: Modified radical inguinal lymph node dissection to ensure radical cure, while reducing the surgical complications.