【摘要】 目的探讨腔镜下阴茎癌双侧腹股沟淋巴结清扫术的效果。方法 2009年9月～2011年11月对14例阴茎癌行腔镜下双侧腹股沟淋巴结清扫术。术前对腹股沟淋巴结和隐静脉进行多普勒超声扫描和盆腔淋巴CT检查,术中建立人工手术腔隙,置入腔镜以及操作器械,先用超声刀扩大皮下腔隙,向上至腹股沟韧带上方的腹外斜肌腱膜,外侧至缝匠肌外缘,内侧为长收肌内侧,下界为股三角顶端,解剖出股动静脉、大隐静脉及其分支,并切除该范围内的淋巴结和脂肪组织,从穿刺孔取出清扫的淋巴结和脂肪组织,术后置引流管引流。结果 14例均顺利完成腔镜下腹股沟淋巴清扫术,术中未发生并发症。手术时间平均103 min(95～112 min),术中出血量平均85 ml(20～130 ml)。双侧切除淋巴结共5～14枚,平均9枚,淋巴结均阴性。术后留置引流管平均5 d(3～7 d)。术后住院5～8 d,平均6 d。1例出现淋巴囊肿,2个月后消退,其余患者未发生股血管损伤、皮缘坏死、愈合延迟、皮下积液和淋巴漏等切口相关的并发症。14例术后随访6～20个月,平均9个月,患者无明显双下肢肿胀及活动障碍。结论腔镜下阴茎癌双侧腹股沟淋巴结清扫术可以保证清扫范围并减少标准开放手术带来的切口相关并发症。更多还原

【Abstract】 Objective To explore the efficacy of bilateral lymphadenectomy for penile carcinoma.Methods From September 2009 to November 2011,14 patients with penile carcinoma underwent laparoscopic bilateral inguinal lymph node dissection in our hospital.Preoperative Doppler ultrasound mapping of the inguinal lymph nodes and the saphenous vein was performed.A subcutaneous space superficial to the Scarpa’s fascia was created.The important landmark structures that must be identified were the inguinal ligament,spermatic cord,femoral vessels,and saphenous vein.The borders of the dissection included the sartorius muscle laterally,the adductor longus muscle medially,the inguinal ligament and spermatic cord superiorly.All the lymph nodes identified along the saphenous vein and arch,as well as those in the path of the superficial epigastric vein,were removed.The nodal packet was placed in an impermeable sac and then extracted.Drainage tubes were placed through the initial port site.Results No intraoperative complications occurred.The mean operation time was 103 min(95-112 min),and mean intraoperative blood loss was 85 ml(20-130 ml).The mean number of lymph nodes excised was 9(5-14),and the lymph nodes were negative.The mean hospitalization was 6 days(5-8 days).Lymphoceles developed in one patient,and subsided two months later.No wound-related complications were seen.At a mean follow-up of 9 months(range from 6 to 20 months),no signs of recurrence or disease progression was noted.Conclusion Laparoscopic bilateral inguinal lymph node dissection is a safe and feasible technique that appears to diminish the wound-related complications associated with standard open approach.更多还原