CAJ | 학술논문

目的：探讨在腔镜腹股沟淋巴结清扫术（V EIL ）中应用基于解剖标示下的区域淋巴结整块清除法的可行性。方法在2012年5月至2014年3月间对5例阴茎癌患者行双侧VEIL。术中将Camper's筋膜浅层、股血管表面、内收肌的外侧缘、缝匠肌的内侧缘、腹股沟韧带上2 cm、股三角的顶部作为清扫范围的解剖标示，建立前、后、左、右、上、下6个解剖平面，将区域内的腹股沟浅组及深组淋巴结、阔筋膜、大隐静脉节段等组织整块清除。结果所有患者均顺利完成手术，手术时间（63．5±8．8）min／侧，引流管拔除时间（6．6±1．4）d ，淋巴结清扫数目（9．4±2．7）枚／侧，其中1例患者在双侧腹股沟区均检出阳性淋巴结（左侧5枚，右侧1枚）和组织癌结节（左、右各1枚），整个手术过程基本无出血。并发症包括血清肿1侧，下肢水肿1侧，术后总并发症发生率20％（2／10）。中位随访时间为22个月（13～35个月），清扫术中检出阳性淋巴结的患者术后5个月出现皮肤转移，其余患者未出现局部复发和远处转移。结论在V EIL中采用基于解剖标示下的区域淋巴结整块清除法安全、可行，并发症发生率低，同时降低手术难度，缩短学习曲线，有利于术式标准化及推广。
목적：탐토재강경복고구림파결청소술（V EIL ）중응용기우해부표시하적구역림파결정괴청제법적가행성。방법재2012년5월지2014년3월간대5례음경암환자행쌍측VEIL。술중장Camper's근막천층、고혈관표면、내수기적외측연、봉장기적내측연、복고구인대상2 cm、고삼각적정부작위청소범위적해부표시，건립전、후、좌、우、상、하6개해부평면，장구역내적복고구천조급심조림파결、활근막、대은정맥절단등조직정괴청제。결과소유환자균순리완성수술，수술시간（63．5±8．8）min／측，인류관발제시간（6．6±1．4）d ，림파결청소수목（9．4±2．7）매／측，기중1례환자재쌍측복고구구균검출양성림파결（좌측5매，우측1매）화조직암결절（좌、우각1매），정개수술과정기본무출혈。병발증포괄혈청종1측，하지수종1측，술후총병발증발생솔20％（2／10）。중위수방시간위22개월（13～35개월），청소술중검출양성림파결적환자술후5개월출현피부전이，기여환자미출현국부복발화원처전이。결론재V EIL중채용기우해부표시하적구역림파결정괴청제법안전、가행，병발증발생솔저，동시강저수술난도，축단학습곡선，유리우술식표준화급추엄。
ABSTRACT:Objective To explore the feasibility of regional lymph node dissection based on anatomic landmarks in video endoscopic inguinal lymphadenectomy (VEIL) .Methods Bilateral VEIL was performed in 5 cases of penile cancer during May 2012 and Mar .2014 .During operation ,Camper's superficial fascia ,superficial femoral artery ,adductor outer edge ,sar‐torius inner edge ,area 2 cm above the inguinal ligament ,and the top of triangle stocks served as anatomic landmarks of dissec‐tion ,and then tissues with the superficial inguinal lymph node ,deep lymph nodes ,fascia lata ,and saphenous vein were re‐moved .Results All operations were successful .The operative time was (63 .5 ± 8 .8)min/side ,drainage tube removal time was (6 .6 ± 1 .4)days ,and the number of dissected lymph nodes was 9 .4 ± 2 .7/side .One patient had positive lymph nodes (left 5 ,right 1) and tissue nodules (left 1 ,right 1) in the inguinal region .No intraoperative bleeding occurred .Postoperative com‐plications included seroma in 1 case ,and leg edema in 1 case .The total postoperative complication rate was 20% (2/10) .Me‐dian follow‐up time was 22 months (13-35 months) .The patient who had positive lymph node during dissection developed skin metastasis 5 months after surgery .Other patients had no local recurrence or distant metastasis .Conclusions Regional lymph node dissection based on anatomic landmarks in video endoscopic inguinal lymphadenectomy is simple ,safe and feasible ,with advantages of low complication rate ,and shorter learning curve .It is worth of standardization and promotion .