【摘要】：目的： 評價腹腔鏡下腹股溝淋巴結(jié)清掃術(shù)的安全性及可靠性,前瞻性研究保留大隱靜脈在腹腔鏡下腹股溝淋巴結(jié)清掃術(shù)中的可行性及在降低術(shù)后并發(fā)癥中的作用。 方法： 2013年1月-2013年12月對20名cN0陰莖癌施行腹腔鏡下雙側(cè)腹股溝預(yù)防性清掃術(shù)。前瞻性設(shè)計在術(shù)中隨機選取一側(cè)擬施行保留大隱靜脈的腹腔鏡下腹股溝淋巴結(jié)清掃術(shù)作為保留組,而另一側(cè)擬切除大隱靜脈的腹腔鏡下腹股溝淋巴結(jié)清掃術(shù)作為不保留組,將保留組同不保留組作自身對照研究。同時,術(shù)中對腹股溝深組淋巴結(jié)進行快速冰凍切片病理檢查,一旦出現(xiàn)陽性則該名患者排除于以上前瞻性設(shè)計方案,改行“腹腔鏡下根治性髂腹股溝淋巴結(jié)清掃術(shù)+盆腔清掃術(shù)”。對保留組、不保留組在手術(shù)資料、病理結(jié)果、術(shù)后并發(fā)癥情況方面進行對比分析。 結(jié)果： 對20名患者共40側(cè)均成功施行了腹腔鏡下腹股溝淋巴結(jié)清掃術(shù),無一例中轉(zhuǎn)開放手術(shù)；且40側(cè)術(shù)中活檢均為陰性,無一例需加行盆腔淋巴結(jié)清掃術(shù)。隨機選取20側(cè)成功地保留了大隱靜脈,另20側(cè)行切除大隱靜脈處理。保留組與不保留組在手術(shù)時間、術(shù)中出血量、引流管拔出時間無明顯差異；清掃出的淋巴結(jié)數(shù)目及淋巴結(jié)陽性數(shù)目無明顯差異。術(shù)后并發(fā)癥方面,兩組均未出現(xiàn)皮瓣壞死等嚴重并發(fā)癥,保留組僅出現(xiàn)1例血清腫,不保留組有1例傷口感染、2例血清腫、3例淋巴囊腫、5例輕度下肢水腫,但統(tǒng)計學分析顯示,兩組僅在下肢水腫方面有顯著差異。 結(jié)論： 本研究腹腔鏡下腹股溝淋巴結(jié)清掃術(shù)是安全可靠的,術(shù)中保留大隱靜脈不延長手術(shù)時間、不增加手術(shù)難度、不影響控瘤效果,且能一定程度上減少并發(fā)癥的發(fā)生,尤其能明顯降低下肢水腫的發(fā)生率,提高了患者的生活質(zhì)量。因此保留大隱靜脈的腹股溝淋巴結(jié)清掃術(shù)是有效可行的,值得臨床推廣。
[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.
【學位授予單位】：中南大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R737.27

【參考文獻】

相關(guān)期刊論文 前4條

1 張杰秀;張煒(小);宋日進;張煒(大);;腹腔鏡下陰莖癌腹股溝淋巴結(jié)清掃術(shù)1例報道[J];南京醫(yī)科大學學報(自然科學版);2010年09期

2 ;2011版《中國泌尿外科疾病診斷治療指南》出版發(fā)行[J];泌尿外科雜志(電子版);2011年03期

3 張小玲;李慧芹;盛修貴;陳真云;李大鵬;李慶水;馬志芳;王岸聰;陳月婷;;外陰惡性腫瘤腹股溝淋巴結(jié)清掃術(shù)中保留大隱靜脈在降低術(shù)后并發(fā)癥中的價值[J];腫瘤;2007年01期

4 周學魯;張繼峰;;腹腔鏡腹股溝淋巴結(jié)清掃術(shù)在陰莖癌治療中的研究進展[J];中國微創(chuàng)外科雜志;2012年11期

，

本文編號：2149516