Department of Urology, Emory University, 1365 Clifton Road NE, Building B, Suite 1400, Atlanta, GA 30322, USA.
Eur Urol. 2009 Nov;56(5):821-8. doi: 10.1016/j.eururo.2009.07.003. Epub 2009 Jul 15.
Inguinofemoral lymphadenectomy can serve as a diagnostic and potentially therapeutic procedure in a variety of malignancies, including those of the genitalia and the skin. Historically, this procedure was associated with significant morbidity.
We hypothesized that both superficial and deep groin dissection (complete inguinofemoral lymphadenectomy) could be performed endoscopically, in a step-by-step manner, with low morbidity, including those patients with obesity and previously treated groins.
DESIGN, SETTING, AND PARTICIPANTS: Twenty-five groin dissections were undertaken in 16 patients, male and female, over a 12-mo time period.
The femoral triangle was marked. An initial fingers' breadth-sized incision was made 3 cm below the apex of the femoral triangle. Finger dissection was used to develop the skin flaps at the apex of the triangle out to two additional 10-mm ports. The anterior space was dissected, and, following that, the saphenous vein was transected distally with an endoscopic stapler. The lateral planes on the adductor longus and sartorius muscles were developed, and, finally, the posterior plane was developed, lifting the packet off the fascia lata. Deep femoral nodes were removed as well. The saphenofemoral junction was transected and the packet was removed. A drain was placed.
The number of lymph nodes harvested was recorded. The development of skin complications, leg edema, and deep venous thrombosis was recorded as well.
The average length of procedure was 147 min. The mean number of lymph nodes harvested was nine. A groin seroma requiring further drainage was observed in one patient. Cellulitis was observed in two patients.
Leg endoscopic groin lymphadenectomy (LEG procedure) is straightforward to learn, with operative times that parallel the open procedure. Less morbidity has been observed in our first group of patients compared to contemporary open series.
腹股沟淋巴结切除术可作为多种恶性肿瘤（包括生殖器和皮肤恶性肿瘤）的诊断和潜在治疗手段。从历史上看，该手术与显著的发病率有关。
我们假设可以通过逐步内窥镜方式进行浅表和深部腹股沟解剖（完全腹股沟淋巴结切除术），且发病率低，包括肥胖和先前治疗过腹股沟的患者。
设计、地点和参与者：在 12 个月的时间内，16 名男性和女性患者共进行了 25 例腹股沟解剖。
标记股三角。在股三角顶点下方 3cm 处做一个初始的手指宽度切口。手指解剖用于在三角顶点处将皮肤瓣向外发展到另外两个 10mm 端口。解剖前间隙，然后用内镜吻合器切断远端的隐静脉。在长收肌和缝匠肌的外侧平面上进行解剖，最后解剖后平面，将包裹物从阔筋膜上提起。同时取出深部股淋巴结。切断腹股沟韧带下的隐股交界，并取出包裹物。放置引流管。
记录采集的淋巴结数量。记录皮肤并发症、腿部水肿和深静脉血栓形成的发展情况。
手术平均时长为 147 分钟。平均采集的淋巴结数量为 9 个。1 例患者出现腹股沟血清肿需要进一步引流。2 例患者出现蜂窝织炎。
腿部内镜腹股沟淋巴结切除术（LEG 手术）易于学习，手术时间与开放手术相当。与当代开放系列相比，我们的第一组患者观察到的发病率较低。
