Ito Hiroki, Arao Masayuki, Ishigaki Hanako, Shirai Akira, Yamasaka Tomomi, Hirai Kotaro
Department of Urology, National Hospital Organization Sagamihara National Hospital.
Nihon Hinyokika Gakkai Zasshi. 2012 Jan;103(1):22-6. doi: 10.5980/jpnjurol.103.22.
Wound necrosis and groin lymphorrhea after inguinal lymph nodes dissection are serious complications. But treatment options for these complications are somewhat controversial. We report a patient who underwent an inguinal lymph node dissection for a regional metastasized squamous cell carcinoma of penis. Unfortunately, a extensive wound necrosis occurred with lymphorrhea (300 cc daily). After operative debridement, negative pressure wound therapy was started. We had used the instrument "V.A.C. (Vacuum Assisted Closure) ATS Therapy System" (KCI U.S.A.). After 11 days of negative pressure wound therapy, the good formation granulation tissue was observed and the lymphatic leakage was prominently decreased. This therapy was performed without serious complications but tolerable localized pain due to negative pressure. There were only seven reports that gave the description of an approach using negative pressure wound therapy for the less invasive treatment of lymphocutaneous fistulas and evaluated the efficacy of this therapy as an alternative medical procedure for treating lymphorrhea. This case suggested that negative pressure wound therapy could not only promote wound healing but also improve intractable lymphorrhea.
腹股沟淋巴结清扫术后伤口坏死和腹股沟淋巴漏是严重的并发症。但针对这些并发症的治疗方案存在一定争议。我们报告一例因阴茎局部转移性鳞状细胞癌接受腹股沟淋巴结清扫术的患者。不幸的是，术后出现广泛伤口坏死并伴有淋巴漏（每日300毫升）。手术清创后，开始采用负压伤口治疗。我们使用了“V.A.C.（真空辅助闭合）ATS治疗系统”（美国KCI公司产品）。负压伤口治疗11天后，观察到肉芽组织生长良好，淋巴漏明显减少。该治疗未出现严重并发症，但因负压导致可耐受的局部疼痛。仅有7篇报道描述了采用负压伤口治疗对淋巴皮肤瘘进行微创治疗的方法，并评估了该疗法作为治疗淋巴漏替代医疗手段的疗效。本病例表明，负压伤口治疗不仅能促进伤口愈合，还能改善难治性淋巴漏。
