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目的:评价运用膜性层面(Camper筋膜浅深层之间)分离法在改良根治腹股沟淋巴清扫术中的控瘤效果和并发症。方法:回顾性分析2008年1月~2013年12月间35例阴茎鳞状细胞癌患者的临床资料:患者年龄30~70岁,中位年龄50岁。以Catalona的改良腹股沟淋巴切除为模板,运用膜性层面的分离方法整块剔除双侧阔筋膜上浅组和筛筋膜下股血管前面和内侧深组淋巴脂肪组织。保留阔筋膜和大隐静脉且未行缝匠肌转位。双侧同期清扫20例,分期15例。随访8~69个月,中位随访37个月。追踪患者生存及并发症。结果:35例清除淋巴结总数753枚,平均每人每侧10.8枚。阳性患者80%(28/35),其中单侧阳性85.7%(24/28),双侧阳性14.3%(4/28)。3年总的疾病特异性生存率为95.2%,其中pN0、pN1、pN2均为100%,pN3为75%。保留阴茎局部复发9.5%(2/21)。腹股沟区总并发症23%(8/35),包含切口感染5.7%(2/35),下肢及阴囊淋巴肿8.6%(3/35),局部复发8.6%(3/35);未发生皮瓣坏死及植皮;无下肢静脉血栓。结论:膜性层面分离法疗效与经典根治术相似,并发症明显降低。
OBJECTIVE: To evaluate the tumorigenicity and complications of modified radical inguinal lymphadenectomy using the membranous (shallow depth between Camper fascia) separations. Methods: The clinical data of 35 patients with penile squamous cell carcinoma from January 2008 to December 2013 were retrospectively analyzed. The patients were 30-70 years old with a median age of 50 years. Catalonous modified inguinal lymphadenectomy as a template, the use of membranous layer separation method, the whole piece removed bilateral fascia and superficial femoral subfascial vessels in the anterior and medial deep group of vascular adipose tissue. Retinal fascia and saphenous vein were retained without sartorius transposition. Bilateral resection in 20 cases, staging in 15 cases. Followed up for 8 to 69 months, with a median follow-up of 37 months. Tracking patient survival and complications. Results: A total of 753 lymph nodes were removed in 35 cases, with an average of 10.8 on each side. Positive patients 80% (28/35), including unilateral positive 85.7% (24/28), bilateral positive 14.3% (4/28). The overall disease-specific survival at 3 years was 95.2%, with 100% for pN0, pN1, and pN2, and 75% for pN3. Remaining penile local recurrence 9.5% (2/21). The total complications in the inguinal region were 23% (8/35), including 5.7% (2/35) of incision infections, 8.6% (3/35) of lower limbs and scrotal lymph nodes, and 8.6% (3/35) of local recurrences. Flap necrosis and skin grafting; no lower extremity venous thrombosis. CONCLUSION: Membrane separation is similar to classic radical mastectomy and the complication is significantly reduced.