Zhang Xiaoling, Sheng Xiugui, Niu Jun, Li Huiqin, Li Dapeng, Tang Ling, Li Qingshui, Li Qingju
Department of Gynecologic Oncology, Shandong Cancer Hospital and Institute, Jinan, 250117, Shandong, PR China.
Gynecol Oncol. 2007 Jun;105(3):722-6. doi: 10.1016/j.ygyno.2007.02.011. Epub 2007 Apr 3.
This work was set out to investigate the effect of saphenous vein preservation during inguinal lymphadenectomy for patients with vulval malignancies.
64 patients with vulval malignancies were allocated into two groups depending on their clinical stages, with one of them (31 patients included) being subjected to sparing of saphenous vein and the other to saphenous vein ligated surgery while treated with inguinal lymphadenectomy. The operative time, blood loss, 5-year survival rate, short- and long-term postoperative complications, 5-year survival rate and groin recurrence were selected as the monitored parameters, through which the above two groups were compared with each other using t test, chi2 and life table analysis.
(1) The median operative time for bilateral inguinal lymphadenectomy was 155 min (130-170 min) in the sparing group, compared to 140 min (120-170 min) in the excision group (P>0.05). The median intraoperative blood loss was 295 mL (100-450 mL) in the sparing group, and 270 mL (150-390 mL) in the excision group (P>0.05). (2) Short-term lower extremity lymphedema occurred with 27 patients (43.5%) in the sparing group and 44 patients (66.7%) in the excision group (P<0.01). Still, short-term lower extremity phlebitis was observed with 7 patients (11.3%) in the sparing group while 17 developed phlebitis (25.8%) in the excision group (P<0.05). However, there was no statistical difference in postoperative fever, acute cellulites, seroma, or lymphocyst formation. (3) Long-term complication occurrence rate decreased by about 50% in patients subjected to saphenous vein sparing surgery compared with those to ligated surgery, while there was no remarkable difference between two groups in the occurrence rates of phlebitis and deep venous thrombosis (P>0.05). (4) The overall 5-year survival rate was 67.3%, with 66.7% and 68.0% for the excision group and the sparing group, respectively (P>0.05).
The application of saphenous vein preservation technique during inguinal lymphadenectomy for patients with vulval malignancies could significantly decrease the occurrence rate of postoperative complications without compromising outcomes and should be widely put into clinical practice.
本研究旨在探讨外阴恶性肿瘤患者腹股沟淋巴结清扫术中保留大隐静脉的效果。
64例外阴恶性肿瘤患者根据临床分期分为两组，其中一组（31例）行保留大隐静脉的腹股沟淋巴结清扫术，另一组行大隐静脉结扎的腹股沟淋巴结清扫术。选择手术时间、出血量、5年生存率、术后近期及远期并发症、5年生存率及腹股沟复发情况作为监测指标，采用t检验、χ²检验和寿命表分析对两组进行比较。
（1）保留组双侧腹股沟淋巴结清扫术的中位手术时间为155分钟（130 - 170分钟），切除组为140分钟（120 - 170分钟）（P>0.05）。保留组术中中位出血量为295毫升（100 - 450毫升），切除组为270毫升（150 - 390毫升）（P>0.05）。（2）保留组27例（43.5%）出现短期下肢淋巴水肿，切除组44例（66.7%）（P<0.01）。保留组7例（11.3%）出现短期下肢静脉炎，切除组17例（25.8%）（P<0.05）。然而，术后发热、急性蜂窝织炎、血清肿或淋巴囊肿形成方面无统计学差异。（3）与结扎手术患者相比，保留大隐静脉手术患者的远期并发症发生率降低约50%，但两组静脉炎和深静脉血栓形成发生率无显著差异（P>0.05）。（4）总体5年生存率为67.3%，切除组和保留组分别为66.7%和68.0%（P>0.05）。
外阴恶性肿瘤患者腹股沟淋巴结清扫术中应用保留大隐静脉技术可显著降低术后并发症发生率，且不影响手术效果，应广泛应用于临床。
