CAJ | 학술논문

目的总结阴茎切除术和改良腹股沟淋巴结清扫术同期治疗阴茎癌的近期临床效果.方法术前5-7天使用抗菌药,阴茎局部及腹股沟区高锰酸钾溶液泡洗,先行阴茎部分切除术或阴茎全切+会阴尿道造口术,同期行改良腹股沟淋巴结清扫术.清扫时皮肤切缘缝线作为牵引,沿浅筋膜浅层和浅筋膜深层之间少血管平面分离,术后皮瓣下置多孔引流管接负压吸引,皮瓣用丝线固定于相应位置的深筋膜处,皮缘处分浅筋膜浅层,皮肤两层缝合.结果中位术后住院日14天(范围10～18天),出院时伤口痊愈或仅有小的并发症.伤口部分裂开1侧.皮肤切口边缘坏死6侧(30%),无腹股沟皮瓣感染或深静脉血栓.无下肢淋巴水肿、淋巴囊肿或血肿.随访1-28个月.平均18个月.无瘤生存10例,无阴茎或腹股沟处复发.结论阴茎切除术和改良腹股沟淋巴结清扫术同期治疗阴茎癌,并发症发生率无增高.采用改良的腹股沟清扫术可以降低并发症的发生率.由于病例数少,随访时间短,对预防腹股沟淋巴结复发和提高患者长期生存率有待进一步的临床研究.
목적 총결음경절제술화개량복고구림파결청소술동기치료음경암적근기림상효과.방법 술전5-7천사용항균약,음경국부급복고구구고맹산갑용액포세,선행음경부분절제술혹음경전절+회음뇨도조구술,동기행개량복고구림파결청소술.청소시피부절연봉선작위견인,연천근막천층화천근막심층지간소혈관평면분리,술후피판하치다공인류관접부압흡인,피판용사선고정우상응위치적심근막처,피연처분천근막천층,피부량층봉합.결과 중위술후주원일14천(범위10～18천),출원시상구전유혹부유소적병발증.상구부분렬개1측.피부절구변연배사6측(30%),무복고구피판감염혹심정맥혈전.무하지림파수종、림파낭종혹혈종.수방1-28개월.평균18개월.무류생존10례,무음경혹복고구처복발.결론 음경절제술화개량복고구림파결청소술동기치료음경암,병발증발생솔무증고.채용개량적복고구청소술가이강저병발증적발생솔.유우병례수소,수방시간단,대예방복고구림파결복발화제고환자장기생존솔유대진일보적림상연구.
Objectives The comtemporary morbidly from penectomy and immediate modified inguinal lymphadenectomy for penile carcinoma was assessed.Methods A broad-spectrum parental antibiotics was given 5 to 7 days preoperatively.Wash the operative site with 1:5000 permanganic acid solution from admission.After partial penectomy or total penectomy and perineal urethrostomy,immediate modified inguinal lymphadenectomy was performed.The extention of our modified inguinal lymphadenectomy was similar with that described by Catalona WJ.Place suture traction on the skin flap and handle the flap gently.Dissect carefully beneath the superficial layer of the superficial fascia,assessing the proper cleavage plane to avoid damage to the vessels and spare skin vascularization.Insert a suction drain through nondissected areas,which was connected with a vacuum aspiration device.The flap was fixed by non-absorbable sutures that incorporated the superficial layer of the superficial layer of the superficial fascia and the correspondent deep fascia.Close the skin and the superficial layer of the superficial fascia,respectively.Results The duration of postoperative hospitalization ranged from 10 days to 18 days,with a median of 14 days.The skin flaps healed with no complication or minor complications.There was incision decoherence in 1 groin and small flap edge necrosis in 6 (30% ) groins.There were no large skin flap necrosis,no deep venous thrombosis,no lower extremity edema,no lymphocele or hematoma.The duration of followup ranged from 1 month to 28 months,with a mean of 18 months.Ten patients all survival without recurrence.Conclusions Contemporary morbidity from penectomy and immediate modified inguinal lymphadenectomy for penile carcinoma did not increase.The morbidity decreased indeed by our modified inguinal lymphadenectomy. However,further clinical investigation is required to confirm the advantage and long-term effect of our modified techniques.