三切口侧入法腔镜下腹股沟淋巴结清扫术的可行性研究(附23例报告)  

Feasibility research of three-incision endoscopic inguinal lymphadenectomy in lateral approach: with a report of 23 cases

作　　者：吴强[1] 赵一兵[1] 孙志华[1] 戴志琴[1] 曲军卫[1] 沈扬[1] 倪静[1] 邵衡华[1] 

机构地区：[1]南京医科大学附属肿瘤医院,江苏省肿瘤医院,江苏南京210009

出　　处：《腹腔镜外科杂志》2015年第12期916-920,共5页Journal of Laparoscopic Surgery

基　　金：江苏省科技厅社会发展项目资助(编号:BS2006072);江苏省干部保健科研项目资助(编号:BJ14019);江苏省肿瘤医院重点专科项目资助(编号:ZS201202)

摘　　要：目的：通过创立微创腹股沟区三切口侧入法,自腹股沟区上外侧进入腹股沟皮下,施行腹股沟淋巴结切除术,探讨其可行性、切除淋巴结数量及手术的安全性。方法：取倒三角形的腹股沟区为手术野,对23例符合外阴癌腹股沟淋巴结清扫术的患者,取腹股沟区上外侧髂前上棘下2~3 cm处作为第一穿刺孔,于其下分别相隔2~3 cm取第二、第三穿刺孔,在施行溶脂吸脂术后,分别穿刺10 mm、5 mm Trocar,置入器械行淋巴结切除术。结果：腹股沟侧方的三切口可方便地进行腔镜手术操作,容易地切除浅组、深组淋巴结,23例患者腹股沟区每侧切除的淋巴结数量平均（7.9±3.9）枚;技术成熟后的后20例每侧平均（8.5±3.9）枚。术中无麻醉、手术并发症发生,术后腹股沟创面愈合后皮肤表面平坦,皮色正常,三切口疤痕小。术后22例为Ⅰ期愈合,另1例合并糖尿病者腹股沟区延期愈合。结论：三切口侧入法腔镜腹股沟淋巴结清扫术切除淋巴结数量可达到常规手术的标准;创面Ⅰ期愈合率显著优于常规大切口手术;本切口同时兼顾了美容作用,值得临床应用。Objective：The feasibility,safety and the number of the removed lymph nodes were investigated in the resection of inguinal lymph nodes through the three-incision and lateral approach method, the minimal invasive surgery was performed in the inguinal region from the lateral superior side into the subcutaneous tissue. Methods ：The inverted triangle inguinal region was taken as the surgical field, and 23 patients with vulvar cancer accepted the resection of inguinal lymph nodes, the first puncture was made at 2-3 cm inferior the anterior superior iliac spine of the lateral superior inguinal region,with the second and third puncture under it 2-3 cm between each other, after lipolysis and liposuction,the 10 mm and 5 mm puncture Trocars were used respectively, and the medical devices were placed to perform the resection of inguinal lymph nodes. Results ：Three-incision lateral approach method of endoscopic inguinal lymphadenectomy was a easy technique, superficial node and deep node could be resected easily. Lymph nodes resected were （7.9 ± 3.9 ） on each side in 23 cases, and （ 8.5± 3.9） by proved technique in later 20 cases. There were no anesthetic complications or operative complications during the operation. The skin surface was smooth with normal color, and the scars of the three incisions were small. Twentytwo cases presented healing by first intention, and one case with diabetes presented delayed healing. Conclusions： The number of the removed lymph nodes can reach the standard of the conventional lymphadenectomy for the endoscopic resection of inguinal lymph nodes with the three-incision and lateral approach method, the ratio of healing by first intention is significantly superior to the conventional large incision surgery;besides, the incision is also helpful in cosmetology ,thus it is recommended in clinical practices.

关 键 词：外阴肿瘤 腹股沟 淋巴结切除术 腹腔镜检查 

分 类 号：R737.35[医药卫生—肿瘤]