浸润性阴茎癌腹股沟淋巴结清扫术的发病率。

Morbidity of inguinal lymphadenectomy for invasive penile carcinoma.

作者信息

Bouchot Olivier, Rigaud Jérome, Maillet Frédéric, Hetet Jean François, Karam Georges

机构信息

Clinique Urologique, CHU Hôtel Dieu, BP 1005, 44093 Nantes Cedex, France.

出版信息

Eur Urol. 2004 Jun;45(6):761-5; discussion 765-6. doi: 10.1016/j.eururo.2003.12.003.

DOI:10.1016/j.eururo.2003.12.003

PMID:15149749

Abstract

OBJECTIVE

To determine the incidence and the consequences of complications related to modified and radical inguinal lymphadenectomy in patients with invasive penile carcinoma, defined by invasion of the corpus spongiosum or cavernosum (> or =T2).

MATERIALS AND METHODS

A total of 118 modified (67.0%), and 58 radical (33.0%) inguinal lymphadenectomy were performed in 88 patients between 1989 and 2000. To decrease the morbidity, radical inguinal lymphadenectomy was proposed only in patients with palpable inguinal lymph nodes, uni- or bilaterally (N1 or N2). Modified inguinal lymphadenectomy was performed bilaterally in patients with invasive penile carcinoma and non-palpable inguinal lymph nodes (N0), and unilaterally in the side without inguinal metastases in N1 patients. Complications were assessed retrospectively with a median follow-up of 46 months and classified as early (event observed during the 30 days after the procedure) or late (event present after hospitalisation or after the first months).

RESULTS

A total of 74 complications after 176 procedures were recorded. After modified inguinal lymphadenectomy, 8 early (6.8%) and 4 late (3.4%) complications were observed. There were a total of 110 dissections with no complications and 8 dissections with 1 or 2 complications. After radical inguinal lymphadenectomy, the morbidity increased with 24 early (41.4%) and 25 late (43.1%) complications, observed in only 18 of 58 radical procedures. Leg oedema was the most common late complication, interfering with ambulation in 13 cases (22.4%).

CONCLUSION

Modified inguinal lymphadenectomy, with saphenous vein sparing and limited dissection offers excellent functional outcome in patients with invasive penile carcinoma and nonpalpable inguinal lymph nodes. The morbidity after radical lymphadenectomy still significant, especially in patients with multiple or bilateral superficial inguinal lymph nodes treated by pelvic and bilateral inguinal lymphadenectomy.

摘要

目的

确定海绵体或阴茎海绵体受侵（≥T2）的浸润性阴茎癌患者行改良腹股沟淋巴结清扫术和根治性腹股沟淋巴结清扫术相关并发症的发生率及后果。

材料与方法

1989年至2000年期间，88例患者共接受了118例改良腹股沟淋巴结清扫术（67.0%）和58例根治性腹股沟淋巴结清扫术（33.0%）。为降低发病率，仅对腹股沟淋巴结可触及（单侧或双侧，N1或N2）的患者行根治性腹股沟淋巴结清扫术。对浸润性阴茎癌且腹股沟淋巴结不可触及（N0）的患者双侧行改良腹股沟淋巴结清扫术，对N1患者无腹股沟转移的一侧单侧行改良腹股沟淋巴结清扫术。对并发症进行回顾性评估，中位随访时间为46个月，并发症分为早期（术后30天内观察到的事件）或晚期（住院后或最初几个月后出现的事件）。

结果

176例手术共记录到74例并发症。改良腹股沟淋巴结清扫术后，观察到8例早期并发症（6.8%）和4例晚期并发症（3.4%）。共有110例清扫无并发症，8例清扫有1或2例并发症。根治性腹股沟淋巴结清扫术后，发病率增加，58例根治性手术中仅18例观察到24例早期并发症（41.4%）和25例晚期并发症（43.1%）。腿部水肿是最常见的晚期并发症，13例（22.4%）影响行走。