Bender H G, Werner C, Greuel H, Timp P
Fortschr Med. 1977 Nov 24;95(44):2645-52.
20 patients with histologically verified carcinoma of the vulva fulfilled the following conditions: general operability, preoperative lymphography, radical vulvectomy with inguinal lymph node resection and histological examination of all lymph nodes. It was studied how far the preoperative lymphography plays a role for the strategy of operative treatment of carcinoma of the vulva and eventually in the limitation of risks of operative treatment. A survey of the lymphatic drainage of the vulva underlines the importance of the knowledge of the lymphatic pathways for the operation and for the lymphography as performed in this hospital since 1972. The results suggest that lymphography shows an unacceptable high number of false-negative results in cases of metastatic involvement of the inguinal nodes (7 out of 10 cases), whereas it is reliable for the judgment of the iliac and paraaortal nodes. For this reason the resection of the inguinal nodes remains a necessary part of radical vulvectomy. The additional removal of intrapelvic lymph nodes has been restricted to patients with lymphographic signs of positive nodes. In our opinion preoperative lymphography is of considerable value to minimize the operative risk for patients with carcinoma of the vulva by means of a more precise preoperative diagnosis, stage-oriented therapy and postoperative control.
20例经组织学证实的外阴癌患者符合以下条件：具备全身手术可操作性、术前行淋巴造影、行根治性外阴切除术及腹股沟淋巴结切除术，并对所有淋巴结进行组织学检查。研究了术前淋巴造影在外阴癌手术治疗策略中以及最终在限制手术治疗风险方面所起的作用。对外阴淋巴引流的一项调查强调了了解淋巴途径对于手术以及自1972年以来在本院进行的淋巴造影的重要性。结果表明，在腹股沟淋巴结发生转移的病例中，淋巴造影显示出不可接受的高比例假阴性结果（10例中有7例），而对于判断髂淋巴结和腹主动脉旁淋巴结则是可靠的。因此，腹股沟淋巴结切除术仍然是根治性外阴切除术的必要组成部分。盆腔内淋巴结的额外切除仅限于有淋巴造影显示淋巴结阳性体征的患者。我们认为，术前淋巴造影对于通过更精确的术前诊断、分期导向治疗和术后控制来最大限度降低外阴癌患者的手术风险具有相当大的价值。
