Low pressure video endoscopic inguinal lymphadenectomy in the treatment of penile cancer
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摘要: 目的:探讨低气压腔镜腹股沟淋巴结清扫术在阴茎癌治疗中的临床应用价值。方法:我院2013年1月—2018年1月阴茎癌行腹腔镜下腹股沟淋巴结清扫术共57例患者作为研究对象进行回顾性分析。根据手术时气腹压力的不同分为低气腹压组(气腹压力5~7 mmHg,n=33)及高气腹压组(气腹压力13~15 mmHg,n=24)。清扫范围同标准的开放腹股沟淋巴结清扫术,常规保留阔筋膜,若隐静脉裂孔周围无明显肿大淋巴结,保留大隐静脉主干。结果:两组患者均顺利完成双侧腹股沟淋巴结清扫手术,两组患者的手术时间、术中出血量、淋巴结清扫的数目、术后淋巴液引流天数、术后T分期及N分期比较差异无统计学意义。低气腹压组术中最高动脉血二氧化碳分压(PaCO2)为47(44.5~48.5) mmHg,高气腹压组为55(53.0~57.5) mmHg,两组比较差异有统计学意义。术后3 d低气腹压组D-二聚体显著低于高气腹压组,发生皮下气肿的比例为12.12%,显著低于高气腹压的37.5%。术后随访3~86个月,中位随访46个月。低气腹压组有3例复发,5年无复发生存率为90.1%;高气腹压有6例复发,有3例患者在术后2个月内出现术区皮肤转移,5年无复发生存率为75%。两组患者5年无复发生存率比较差异无统计学意义。结论:腔镜腹股沟淋巴结清扫术治疗阴茎癌患者具有术中出血少、术后并发症少、恢复快、住院时间短等优点。术中保持较低的CO2气压不会影响术中视野,不增加手术难度,且可以减少术中CO2吸收所致高碳酸血症,减少术后皮下及阴囊气肿,是一项安全有效的手术。Abstract: Objective: To investigate the clinical value of laparoscopic inguinal lymph node dissection in the treatment of penile cancer.Methods: From January 2013 to January 2018, 57 patients with penile cancer undergoing laparoscopic inguinal lymph node dissection were retrospectively analyzed. According to the different pneumoperitoneum pressures during operation, they were divided into low pneumoperitoneum pressure group(5-7 mmHg, n=33) and high pneumoperitoneum pressure group(13-15 mmHg, n=24). The scope of dissection was the same as that of standard open inguinal lymph node dissection, and the main saphenous vein trunk was reserved if there was no obvious enlarged lymph node around the saphenous vein hiatus.Results: Two groups of patients were successfully completed bilateral inguinal lymph node dissection surgery. Operation time, intraoperative blood loss, number of lymph node dissection, postoperative lymph drainage days, postoperative T stage or N stage had no statistical difference between two groups of patients. The highest arterial partial pressure of carbon dioxide(PaCO2) was 47(44.5-48.5) mmHg in the low-pressure group and 55(53.0-57.5) mmHg in the high-pressure group. The incidence of subcutaneous emphysema was 12.12%, which was significantly lower than 37.5% of high pneumoperitoneum. The patients were followed up for 3 to 86 months(median, 46 months). In the low pneumoperitoneum group, 3 cases recurred, and the 5-year recurrence free survival rate was 90.1%. In the high pneumoperitoneum pressure group, 6 cases recurred, and 3 cases had skin metastasis in the operation area within 2 months after operation. The 5-year recurrence free survival rate was 75%. There was no significant difference in the 5-year recurrence free survival rate between the two groups.Conclusion: Endoscopic inguinal lymph node dissection has the advantages of less intraoperative bleeding, fewer postoperative complications, faster recovery and shorter hospital stay. It can reduce the hypercapnia caused by carbon dioxide absorption and reduce the subcutaneous and scrotal emphysema. It is a safe and effective operation.
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Key words:
- penile cancer /
- laparoscope /
- lymph node dissection /
- low pneumoperitoneum pressure
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