Tropé C, Scheistrøen M, Aas M, Abeler V, Lie K, Makar A
Avdeling for gynekologisk onkologi, Det Norske Radiumhospital 0310 Oslo.
Tidsskr Nor Laegeforen. 2001 Sep 30;121(23):2723-7.
Less than radical vulvectomy for primary vulvar cancer has been controversial. Less mutilating surgery without sacrificing benefits in prognosis is warranted.
Based on relevant literature and our own experience, we give a review of surgery and sentinel node examination in early vulvar cancer.
Regional lymph node metastasis rarely occurs when tumour thickness is less than 1 mm. Smaller lesions (< 2 cm in diameter) should therefore be treated by wide excision only and without lymph node dissection. Other T1 lesions with deeper invasion should be radically excised with at least 2 cm margins and extend deep to the inferior fascia of the urogenital diaphragm. Complete inguinal-femoral lymphadenectomy should be performed in patients without groin metastases to avoid a small, but definite risk of recurrence, although the incidence of lymph node metastases for all clinical stage I patients is less than 10%. Lymphatic mapping with 99mTechnetium and patent blue technique is a potentially valuable intraoperative tool for assuring removal of the sentinel node most likely to have metastasis, defining the extent of the superficial inguinal lymphadenectomy and identifying uncommon anatomic variations.
Until reliable data on the benefits of selective lymphadenectomy using intraoperative lymphoscintigraphy are available, the procedure should only be performed in an approved research setting.
原发性外阴癌采用非根治性外阴切除术一直存在争议。需要在不牺牲预后益处的情况下进行创伤较小的手术。
基于相关文献和我们自己的经验，我们对外阴早期癌的手术及前哨淋巴结检查进行综述。
当肿瘤厚度小于1毫米时，区域淋巴结转移很少发生。因此，较小的病变（直径<2厘米）仅应通过广泛切除治疗，无需进行淋巴结清扫。其他浸润较深的T1期病变应进行根治性切除，切缘至少2厘米，深度延伸至泌尿生殖膈下筋膜。对于无腹股沟转移的患者，应进行完整的腹股沟-股淋巴结清扫术，以避免虽小但明确的复发风险，尽管所有临床I期患者的淋巴结转移发生率低于10%。使用锝99m和专利蓝技术进行淋巴绘图是一种潜在有价值的术中工具，可确保切除最可能发生转移的前哨淋巴结，确定浅表腹股沟淋巴结清扫的范围，并识别罕见的解剖变异。
在获得关于使用术中淋巴闪烁显像进行选择性淋巴结清扫益处的可靠数据之前，该手术仅应在经批准的研究环境中进行。
