Mukamel E, deKernion J B
Department of Urology, Beilinson Medical Center Petah Tiqva, Israel.
Urol Clin North Am. 1987 Nov;14(4):707-11.
Assessment of the inguinal lymph nodes for metastases in patients with penile cancer is inaccurate. About 50 per cent of patients with node enlargement have no tumor on histologic examination, and 20 per cent of patients with clinically negative nodes have micrometastases. Lymph-node biopsies, including sentinel-node biopsy, are of limited staging value. Patients with lesions that do not invade the corpora and who have no palpable nodes should be followed carefully after excision of the primary tumor at 2- to 3-month intervals. If compliance with such a follow-up is doubtful, bilateral superficial groin-node dissection seems appropriate. Those with persistent adenopathy should undergo superficial lymph-node dissection first, and if positive nodes are found, bilateral deep-node dissection should then be performed. Bilateral inguinal and pelvic lymphadenectomy is recommended for patients with lesions invading the corpora with clinically negative or positive nodes because of the high incidence of lymph-node metastases in such cases. Where adenopathy persists after excision of the primary tumor, we advocate first limited pelvic dissection. If the pelvic nodes are negative or are not extensively involved, bilateral groin dissection should be performed, preferably in two stages. Percutaneous fine-needle aspiration of palpable or nonpalpable nodes can improve preoperative staging in patients with penile cancer.
评估阴茎癌患者腹股沟淋巴结有无转移并不准确。约50%淋巴结肿大的患者组织学检查未发现肿瘤，20%临床检查淋巴结阴性的患者存在微转移。包括前哨淋巴结活检在内的淋巴结活检的分期价值有限。对于病变未侵犯海绵体且未触及淋巴结的患者，在原发肿瘤切除后应每隔2至3个月进行仔细随访。如果对这种随访的依从性存疑，双侧腹股沟浅淋巴结清扫术似乎是合适的。那些持续性淋巴结病患者应首先进行腹股沟浅淋巴结清扫术，如果发现阳性淋巴结，则应随后进行双侧腹股沟深淋巴结清扫术。对于病变侵犯海绵体且临床检查淋巴结阴性或阳性的患者，建议行双侧腹股沟及盆腔淋巴结切除术，因为此类病例中淋巴结转移的发生率很高。如果在原发肿瘤切除后淋巴结病持续存在，我们主张首先进行有限的盆腔清扫术。如果盆腔淋巴结阴性或未广泛受累，应进行双侧腹股沟清扫术，最好分两期进行。对可触及或不可触及的淋巴结进行经皮细针穿刺可改善阴茎癌患者的术前分期。
