Cabanas R M
Victory Memorial Hospital, Brooklyn, New York.
Urol Clin North Am. 1992 May;19(2):267-76.
Lymphangiograms performed via the dorsal lymphatics of the penis demonstrate drainage into a specific lymph node center, the so-called sentinel lymph node, which is located close to the superficial epigastric vein between the latter and the superficial external pudendal vein. Anatomically, clinically, and pathologically, the sentinel lymph node is the first site of metastasis and often is the only lymph node involved. We recommend preliminary bilateral sentinel lymph node biopsy, with inguinofemoral dissection being performed only when this node is involved. If the biopsies are negative for metastases, no further surgical therapy is immediately indicated, and the patient needs to be observed closely with monthly examination for 1 year and examination every 2 months for 3 years. The clinical staging of cancer of the penis needs a new review for further evaluation of different modalities of treatment. Sentinel lymph node biopsy must not be used to determine whether node dissection is needed in patients with evident clinically positive nodes. Also, the concept of sentinel lymph node should not be applied in the management of patients who will not be available for frequent follow-up. If during physical examination, suspect lymph nodes are found other than the classic sentinel node, these lymph nodes must be removed for staging and subsequent treatment planned according to the histologic report.
通过阴茎背侧淋巴管进行的淋巴造影显示，其引流至一个特定的淋巴结中心，即所谓的前哨淋巴结，该淋巴结位于腹壁浅静脉与阴部外浅静脉之间且靠近腹壁浅静脉。从解剖学、临床和病理学角度来看，前哨淋巴结是转移的首个部位，且通常是唯一受累的淋巴结。我们建议先行双侧前哨淋巴结活检，仅在前哨淋巴结受累时才进行腹股沟股淋巴结清扫术。如果活检结果显示无转移，则无需立即进行进一步的手术治疗，患者需密切观察，在1年内每月检查1次，在接下来的3年中每2个月检查1次。阴茎癌的临床分期需要重新审视，以便进一步评估不同的治疗方式。对于临床上明显有阳性淋巴结的患者，前哨淋巴结活检不能用于确定是否需要进行淋巴结清扫术。此外，对于无法频繁进行随访的患者，前哨淋巴结的概念不适用。如果在体格检查中发现除经典前哨淋巴结以外的可疑淋巴结，必须切除这些淋巴结以进行分期，并根据组织学报告制定后续治疗方案。
