阴茎癌保留大隐静脉的腔镜腹下腹股沟淋巴结清扫术

发布时间：2018-07-28 08:34

【摘要】：目的：评价腹腔镜下腹股沟淋巴结清扫术的安全性及可靠性,前瞻性研究保留大隐静脉在腹腔镜下腹股沟淋巴结清扫术中的可行性及在降低术后并发症中的作用。方法： 2013年1月-2013年12月对20名cN0阴茎癌施行腹腔镜下双侧腹股沟预防性清扫术。前瞻性设计在术中随机选取一侧拟施行保留大隐静脉的腹腔镜下腹股沟淋巴结清扫术作为保留组,而另一侧拟切除大隐静脉的腹腔镜下腹股沟淋巴结清扫术作为不保留组,将保留组同不保留组作自身对照研究。同时,术中对腹股沟深组淋巴结进行快速冰冻切片病理检查,一旦出现阳性则该名患者排除于以上前瞻性设计方案,改行“腹腔镜下根治性髂腹股沟淋巴结清扫术+盆腔清扫术”。对保留组、不保留组在手术资料、病理结果、术后并发症情况方面进行对比分析。结果：对20名患者共40侧均成功施行了腹腔镜下腹股沟淋巴结清扫术,无一例中转开放手术；且40侧术中活检均为阴性,无一例需加行盆腔淋巴结清扫术。随机选取20侧成功地保留了大隐静脉,另20侧行切除大隐静脉处理。保留组与不保留组在手术时间、术中出血量、引流管拔出时间无明显差异；清扫出的淋巴结数目及淋巴结阳性数目无明显差异。术后并发症方面,两组均未出现皮瓣坏死等严重并发症,保留组仅出现1例血清肿,不保留组有1例伤口感染、2例血清肿、3例淋巴囊肿、5例轻度下肢水肿,但统计学分析显示,两组仅在下肢水肿方面有显著差异。结论：本研究腹腔镜下腹股沟淋巴结清扫术是安全可靠的,术中保留大隐静脉不延长手术时间、不增加手术难度、不影响控瘤效果,且能一定程度上减少并发症的发生,尤其能明显降低下肢水肿的发生率,提高了患者的生活质量。因此保留大隐静脉的腹股沟淋巴结清扫术是有效可行的,值得临床推广。
[Abstract]:Objective: to evaluate the safety and reliability of laparoscopic inguinal lymph node dissection, and to study the feasibility of preserving great saphenous vein in laparoscopic inguinal lymph node dissection and the role of preserving great saphenous vein in reducing postoperative complications. Methods: from January 2013 to December 2013, 20 patients with cN0's penile carcinoma underwent laparoscopic bilateral inguinal dissection. The prospective design randomly selected one side of the group with laparoscopic inguinal lymph node dissection to preserve the great saphenous vein as the retention group, while the other side of the large saphenous vein with laparoscopic inguinal lymph node dissection as the unreserved group. A self-controlled study was conducted between the retention group and the non-reservation group. At the same time, the deep inguinal lymph nodes were examined by rapid frozen sections during the operation. Once positive, the patient was excluded from the prospective design. Laparoscopic radical ilioinguinal lymph node dissection was performed. The surgical data, pathological results and postoperative complications were compared between the retention group and the non-reservation group. Results: laparoscopic inguinal lymph node dissection was performed successfully in 40 of the 20 patients, none of them was converted to open surgery, and none of the 40 cases underwent pelvic lymph node dissection. The great saphenous vein was successfully preserved in 20 sides, and the great saphenous vein was resected in the other 20 sides. There was no significant difference between the retention group and the non-reservation group in the operation time, the amount of blood loss during operation, the time of drainage tube pull-out, the number of lymph nodes dissected and the number of positive lymph nodes. In terms of postoperative complications, there were no serious complications such as skin flap necrosis in both groups. In the retention group, there was only 1 case of serum swelling, 1 case of wound infection and 2 cases of serum swelling of lymphoid cyst in 3 cases of mild edema of lower extremity, but statistical analysis showed that there were 5 cases of edema of lower extremity. There was only significant difference in edema of lower extremities between the two groups. Conclusion: laparoscopic inguinal lymph node dissection is safe and reliable. Preserving the great saphenous vein does not prolong the operation time, does not increase the difficulty of operation, and does not affect the tumor control effect. And can reduce the occurrence of complications to a certain extent, especially can significantly reduce the incidence of lower extremity edema, improve the quality of life of patients. Therefore, inguinal lymph node dissection with great saphenous vein preservation is effective and feasible and worthy of clinical promotion.
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.27

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