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目的:研究经下肢皮下通路腹腔镜腹股沟淋巴结切除术(VEIL-L)在外阴癌治疗中的手术方法及近期疗效。方法:2011年3月至2015年2月,对南方医科大学珠江医院收治的6例外阴癌患者(FIGO分期ⅠB期4例、Ⅱ期2例;单侧型病灶3例、中线型3例)施行了VEIL-L及改良广泛外阴切除术。总结VEIL-L术式的手术技巧、观察术后并发症及随访结果。结果:6例患者均成功施行了VEIL-L术式以及改良广泛外阴切除术。6例患者的VEIL-L平均手术时间68.7±9.3分钟(60~85分钟),平均出血量8.8±5.6 ml(5~20 ml),平均淋巴结切除数目17.7±1.9个(16~20个),术后引流管放置时间3.8±1.0天(3~5天),术后腹股沟引流量116.0±20.3 ml(85~139 ml)。术中、术后均无严重并发症发生,1例患者术后2个月内出现单侧腹股沟淋巴囊肿,经物理治疗后痊愈;切口淋巴渗漏1例,加压包扎后自然痊愈。6例患者随访33.7±13.2月(11~46月),随访期间未见肿瘤复发。结论:VEIL-L术式是可行的,该术式可有效降低术后并发症,是外阴癌治疗的又一新技术,未来有待进一步评估其远期疗效。
Objective: To study the surgical methods and short-term curative effect of VEIL-L in the treatment of vulvar cancer through subcutaneous route of lower extremity. Methods: From March 2011 to February 2015, 6 cases of vulvar cancer were treated in Zhujiang Hospital of Southern Medical University (FIGO stage ⅠB 4 cases, Ⅱ 2 cases; unilateral lesions 3 cases, median 3 cases ) Performed VEIL-L and modified extensive vulvectomy. VEIL-L surgical techniques were summarized, postoperative complications and follow-up results were observed. Results: VEIL-L and modified radical vulvectomy were successfully performed in all 6 patients. The mean operative time of VEIL-L in 6 patients was 68.7 ± 9.3 minutes (60-85 minutes), the mean amount of bleeding was 8.8 ± 5.6 ml (5-20 ml) and the average number of lymph nodes was 17.7 ± 1.9 (16-20) Postoperative drainage tube placement time 3.8 ± 1.0 days (3 to 5 days), postoperative inguinal drainage 116.0 ± 20.3 ml (85 ~ 139 ml). There was no serious complications during and after surgery. One patient had unilateral inguinal lymphatic cyst within 2 months after operation and healed after physical therapy. One case of incision lymphatic leakage was recovered after compression bandaging. Six patients were followed up 33.7 ± 13.2 months (11 ~ 46 months), no tumor recurrence during follow-up. Conclusion: The VEIL-L procedure is feasible. This procedure can effectively reduce the postoperative complications and is another new technique for the treatment of vulvar cancer. Future evaluation of its efficacy is needed.