摘要:阴茎鳞状细胞癌 (penile squamous cell carcinoma,PSCC)是一种罕见的生殖器恶性肿瘤。其主要预后因素仍是淋巴结是否存在转移以及淋巴结转移的程度。多年以来,根治性腹股沟淋巴结切除术虽然一直是区域淋巴结治疗的基石,但其仍与显著的术后并发症和心理障碍相关,且在泌尿肿瘤学界在关于根治性腹股沟淋巴结 切除术治疗PSCC的最新进展中存在部分争议。本文旨在讨论目前关于腹股沟淋巴结清扫术在阴茎癌治疗的作用及可能存在的争议。
表1 阴茎癌TNM分期系统的更新
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徐石义,王启林,杨宏,等.阴茎癌治疗中的腹股沟淋巴结清扫术[J]. 泌尿外科杂志(电子版),2023,15(2):92-96. DOI:10.20020/j.CNKI.1674-7410.2023.02.20
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1 背景
2 腹股沟淋巴结
3 影像学
4 TNM分期系统
5 ILND的适应证、最佳时机及治疗趋势
6 挽救性的ILND
6.1 盆腔淋巴结清扫术
6.2 补救性ILND
6.3 腹膜后淋巴结清扫术
7 降低ILND后的并发症
7.1 囊状淋巴管瘤
7.2 淋巴水肿
7.3 伤口感染
7.4 创面裂开、皮瓣坏死
7.5 深静脉血栓形成
8 结论
LAD仍是阴茎癌外科治疗的基石。随着新手术 方式的出现,如DSNB,改良ILND和微创LAD, 影响着术后并发症的发生和阴茎癌患者的确诊率、 淋巴结转移的确诊率。手术的改良在泌尿外科肿瘤 领域引起了争议,目前仍缺乏针对ILNM的测因子,需要在大容量中心之间进一步合作,以确定针对PSCC患者区域淋巴最佳管理节点。
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