CAJ | 학술논문

目的比较经下腹部皮下通路与下肢皮下通路两种不同途径腹腔镜腹股沟淋巴结清扫术在外阴癌手术治疗中的可行性和安全性.方法 2011年3月至2013年8月对南方医科大学珠江医院妇产科7例外阴鳞癌患者,施行了腹腔镜腹股沟淋巴结清扫术(VEIL).其中,一侧采用下腹部皮下通路(VEIL-H)术式,另一侧采用下肢皮下通路(VEIL-L)术式.清扫范围包括腹股沟浅深淋巴组织,手术同时行改良广泛外阴切除术.比较分析两种不同通路的手术技巧和近期手术效果.结果对7例均同时成功施行了VEIL-H与VEIL-L的联合术式以及改良广泛外阴切除术.平均手术时间、平均出血量、淋巴结清扫数目方面的差异无统计学意义.术后引流管放置时间:VEIL-H侧(4.7±1.4)d、VEIL-L侧(2.7±0.9)d,差异有统计学意义(P＜0.01);术后引流量:VEIL-H侧(123±55) ml、VEIL-L侧(62±32) ml,差异有统计学意义(P＜0.05);术后平均住院时间为(8.6±2.2)d;两种术式伤口均为甲级愈合;术中术后均无严重并发症,VEIL-H侧术中损伤大隐静脉1例;VEIL-H侧术后腹股沟淋巴囊肿1例,经治疗后痊愈;VEIL-L侧淋巴渗漏1例,加压包扎后自然痊愈;随访(19±7)个月,未见肿瘤复发.结论两种微创通路均可安全施行外阴癌腹股沟浅深淋巴结清扫.VEIL-L术式在清扫腹股沟深淋巴结时相对容易暴露,而VEIL-H在需要行盆腹腔手术时则更为方便和微创.
목적 비교경하복부피하통로여하지피하통로량충불동도경복강경복고구림파결청소술재외음암수술치료중적가행성화안전성.방법 2011년3월지2013년8월대남방의과대학주강의원부산과7예외음린암환자,시행료복강경복고구림파결청소술(VEIL).기중,일측채용하복부피하통로(VEIL-H)술식,령일측채용하지피하통로(VEIL-L)술식.청소범위포괄복고구천심림파조직,수술동시행개량엄범외음절제술.비교분석량충불동통로적수술기교화근기수술효과.결과 대7례균동시성공시행료VEIL-H여VEIL-L적연합술식이급개량엄범외음절제술.평균수술시간、평균출혈량、림파결청소수목방면적차이무통계학의의.술후인류관방치시간:VEIL-H측(4.7±1.4)d、VEIL-L측(2.7±0.9)d,차이유통계학의의(P＜0.01);술후인류량:VEIL-H측(123±55) ml、VEIL-L측(62±32) ml,차이유통계학의의(P＜0.05);술후평균주원시간위(8.6±2.2)d;량충술식상구균위갑급유합;술중술후균무엄중병발증,VEIL-H측술중손상대은정맥1례;VEIL-H측술후복고구림파낭종1례,경치료후전유;VEIL-L측림파삼루1례,가압포찰후자연전유;수방(19±7)개월,미견종류복발.결론 량충미창통로균가안전시행외음암복고구천심림파결청소.VEIL-L술식재청소복고구심림파결시상대용역폭로,이VEIL-H재수요행분복강수술시칙경위방편화미창.
Objective To describe and compare video endoscopic inguinal lymphadenectomy via hypogastric and limb approach (VEIL-H vs VEIL-L) in patients with invasive vulvar cancer.Methods From March 2011 to August 2013,7 women with early-stage vulvar cancer were selected for this integrated procedure with a combination of VEIL-H and VEIL-L in bilateral groins.VEIL-L was performed on limb with old surgical scar in ipsilateral hypogastric area of 3 patients and VEIL-H in contralateral limb.Both novel procedures were performed with triple trocars respectively.The boundaries of inguinal lymph node dissection were the same template of open inguinal lymphadenectomy.Preoperative data,surgical techniques and followup outcomes were compared.Standard statistical tests were used.Results The combination of VEIL-H and VEIL-L was successfully completed in 7 patients without conversion into open surgery.The great saphenous vein was spared in 13 limbs.No difference existed in mean operative duration,average blood loss volume and median total regional lymph nodes removed in two groups.All nodes were confirmed tumor-free.Mean drain duration was (4.7 ± 1.4) days in the VEIL-H group and (2.7 ±0.9) days in VEIL-L group respectively (P ＜ 0.01).Mean drain volume was (123 ± 55) ml in VEIL-H group and (62 ± 32) ml respectively (P ＜0.05).Mean postoperative hospital stay was (8.6 ± 2.2) days.No major intraoperative complications occurred.However,hypercarbia in one patient 1 was completely reversible with hyperventilation.Unilateral great saphenous vein was injured in another one.Regarding postoperative complications,one patient suffered lymphocele in VEIL-H side and another had lymphorrhea through drain orifice in VEIL-L side.During a follow-up period of (19 ± 7) months,there was no disease recurrence so far.Conclusion The combination of VEIL-H and VEIL-L has the reproducibility and therapeutic potentials in the treatment for patients with vulvar cancer.Both minimal invasive techniques are viable.Although short-term results are encouraging,larger series with a longer follow-up are required to fully evaluate the therapeutic efficacy of VEIL-H and VEIL-L.