Modified Radical Vulvectomy and Groin Dissection through Separate Incisions with Great Saphenous Vein and Fascia Lata Preservation

經三處切口施行改良式徹底女陰癌切除與兩側腹股溝淋巴摘除並保留大隱靜脈及外側筋膜

林武周(Wu-Chou Lin) ； 謝耀元(Yao-Yuan Hsieh) ； 張其真(Chi-Chen Chang) ； 徐泰彥(Tai-Yen Hsu) ； 葉聯舜(Lian-Shun Yeh) ； 蔡鴻德(Horng-Der Tsai)

《Mid-Taiwan Journal of Medicine》 3卷2期 (1998/06) Pp. 88-93

https://doi.org/10.6558/MTJM.1998.3(2).4

摘要

鼠蹊淋巴擴清術在女陰癌之治療中屬於重要之一部分對於鼠蹊淋巴擴清手術中均切除部分大隱靜脈及外側筋膜，而發生靜脈栓塞及因傷口潰裂而股血管暴露於外之併發症。本篇研究我們介紹一改良式手術法以減少此併發症，並檢討其療效。1988及1996之間，回溯研究所有原發性侵犯性女陰癌並接受三處切口式徹底女陰癌切除併雙側鼠蹊淋巴擴清術之病人，腹股溝淋巴摘除之範圍包括表層及深部股動脈內側淋巴摘除，大隱靜脈。外側筋膜及篩狀筋膜則予以保留。共十一例侵犯性女陰癌納入本研究，八例呈現第一期，三例呈現第二期女陰癌。術中與術後過程順利，無數中之併發症如股神經或血管之傷害，平均出血量與住院天數為220西西及9.2日。術後併發症罕見，大部分病人於術後一月內回復工作，只有一例術後出現淋巴囊腫與腳水腫，無靜脈栓塞及傷口裂開之病例發生，一例病人死於癌細胞遠處轉移。經三處切口施行改良式徹底女陰癌切除並保留大隱靜脈及外側筋膜之手術方式可達與傳統en bloc方式類似之淋巴腺擴清效果，而併發症率亦低於傳統方式。

關鍵字

女陰癌 ； 徹底女陰癌切除 ； 鼠蹊淋巴擴清術

並列摘要

Surgical removal of groin lymph nodes is an integral part of the surgical management of vulvar cancer. In the process of groin dissection, the great saphenous vein and fascia lata are excised by most gynecologists, which often combine with the wound dehiscence and the vessel exposure. In this series, we presented the modified operative method for preventing these types of complications. Between 1988 and 1996, all patients with invasive early vulvar carcinoma and receiving vulvectomy and inguinal lymphadenectomy through separated inguinal incisions were enrolled. The range of lymphadenectomy included the superficial and medial femoral areas. The great saphenous vein, fascia lata, and cribriform fascia were all preserved. Their perioperative and post-operative courses were reviewed and recorded. Total 11 cases were enrolled in this series. Eight patients presented with stage I and three cases with stage II. Their peri- and postoperative courses were smooth; no intraoperative morbidity, such as femoral vessel or nerve injury, was observed. Average blood loss and hospitalization stays were about 220 ml and 9.2 days, respectively. The postoperative complications were few; and most patients returned to work within 1 month of surgery. One case presented with lymphocele and leg edema. No inguinal wound breakdown was noted. One patient died of distal metastasis. The separate approach in groin dissection was as effective as the en bloc approach. Their follow-up suggested that the modified method of groin lymphadenectomy was as radical as the classic method. A lower morbidity was also observed.

並列關鍵字

vulvar carcinoma ； radical vulvectomy ； groin dissection