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。

[1]SIEGEL, RL,MILLER KD,FUCHS HE,et al. Cancer statistics, 2022 [J]. CA Cancer J Clin,2022,72(1): 7-33. 

[2] THOMAS A,NECCHI A,MUNEER A,et al. Penile cancer [J]. Nat Rev Dis Primers,2021,7(1): 11. 

[3] COELHO RWP,PINHO JD, MORENO JS,et al. Penile cancer in Maranh?o, Northeast Brazil: the highest incidence globally?[J]. BMC Urol,2018,18(1): 50. 

[4] COLBERG C, VAN DER HORST C,JUNEMANN KP, et al.[Epidemiology of penile cancer][J]. Urologe A,2018, 57(4): 408-412. 

[5] EMMANUEL A,NETTLETON J, WATKIN N,et al. The molecular pathogenesis of penile carcinoma- current developments and understanding [J]. Virchows Arch,2019, 475(4): 397-405. 

[6] ALEMANY L,CUBILLA A,HALEC G,et al. Role of Human Papillomavirus in Penile Carcinomas Worldwide [J]. Eur Urol, 2016,69(5): 953-961. 

[7] ZHU Y,YE DW.Lymph node metastases and prognosis in penile cancer [J]. Chin J Cancer Res, 2012, 24(2): 90-96. 

[8] KIEFFER JM, DJAJADININGRAT RS, VAN MUILEKOM EA,et al. Quality of life for patients treated for penile cancer [J]. J Urol,2014,192(4): 1105-1110.

[9] CHIPOLLINI J, TANG DH,SHARMA P,et al. National Trends and Predictors of Organ-sparing for Invasive Penile Tumors: Expanding the Therapeutic Window [J]. Clin Genitourin Cancer,2018,16(2): e383-e389. 

[10] EAU Guidelines Office. EAU-Guidelines-on-Penile-Cancer [J/ OL].(2022-6-10)[2022-6-10]. https://uroweb.org/guidel ine/penile-cancer/ 

[11] AZIZI M,CHIPOLLINI J, PEYTON CC,et al. Current controversies and developments on the role of lymphadenectomy for penile cancer [J]. Urol Oncol,2019,37(3): 201-208. 

[12] ALKATOUT I, NAUMANN CM,HEDDERICH J, et al. Squamous cell carcinoma of the penis: predicting nodal metastases by histologic grade, pattern of invasion and clinical examination [J]. Urol Oncol, 2011,29(6): 774-781. 

[13] HUNGERHUBER E,SCHLENKER B,KARL A,et al. Risk stratification in penile carcinoma: 25- year experience with surgical inguinal lymph node staging [J]. Urology, 2006,68(3): 621-625. 

[14] LEONE A, DIORIO GJ, PETTAWAY C,et al. Contemporary management of patients with penile cancer and lymph node metastasis [J]. Nat Rev Urol,2017,14(6): 335-347. 

[15] MARCONNET L,RIGAUD J, BOUCHOT O. Long-term followup of penile carcinoma with high risk for lymph node invasion treated with inguinal lymphadenectomy [J]. J Urol, 2010,183(6): 2227-2232. 

[16] FICARRA V,AKDUMAN B, BOUCHOT O, et al. Prognostic factors in penile cancer [J]. Urology,2010,76 (2 Suppl 1): S66-S73. 

[17] OBRIEN JS,PERERA M,MANNING T,et al. Penile Cancer: Contemporary Lymph Node Management [J]. J Urol, 2017,197(6):1387-1395. 

[18] SAAD ZZ, OMORPHOS S, MICHOPOULOU S,et al. Investigating the role of SPECT/CT in dynamic sentinel lymph node biopsy for penile cancers [J]. Eur J Nucl Med Mol Imaging,2017,44(7): 1176-1184. 

[19] PANER GP,STADLER WM, HANSEL DE, et al. Updates in the Eighth Edition of the Tumor-Node-Metastasis Staging Classification for Urologic Cancers [J]. Eur Urol, 2018,73(4): 560-569. 

[20] CLARK PE,SPIESS PE,AGARWAL N,et al. Penile cancer: Clinical Practice Guidelines in Oncology [J]. J Natl Compr Canc Netw,2013,11(5): 594-615. 

[21] HEYNS CF, FLESHNER N, SANGAR V, et al. Management of the lymph nodes in penile cancer [J]. Urology,2010, 76(2 Suppl 1): S43-57. 

[22] CHADHA J,CHAHOUD J,SPIESS PE. An update on treatment of penile cancer [J]. Ther Ady Med Oncol, 2022, 14:17588359221127254. 

[23] CHIPOLLINI J, TANG DH, GILBERT SM,et al. Delay to Inguinal Lymph Node Dissection Greater than 3 Months Predicts Poorer Recurrence-Free Survival for Patients with Penile Cancer [J]. J Urol,2017,198(6): 1346-1352.

[24] HEGARTYPK,DINNEY CP,PETTAWAY CA.Controversies in ilioinguinal lymphadenectomy [J]. Urol Clin North Am, 2010,37(3): 421-434. 

[25] CORREA AF,HANDORF E, JOSHI SS, et al. Differences n Survival Associated with Performance of Lymph Node Dissection inPatients with Invasive Penile Cancer: Results from the National Cancer Database [J]. J Urol, 2018,199(5): 1238-1244. 

[26] MATULEWICZ RS,FLUM AS,HELENOWSKI I, et al. Centralization of Penile Cancer Management in the United States: A Combined Analysis of the American Board of Urology and National Cancer Data Base [J]. Urology,2016, 90:82-88. 

[27] CHIPOLLINI J,TANG DH,SHARMA P,et al. Patterns of Regional Lymphadenectomy for Clinically Node-negative Patients With Penile Carcinoma: Analysis From the National Cancer Database From 1998 to 2012 [J]. Clin Genitourin Cancer,2017,15(6): 670-677.e1. 

[28] JOSHI SS, HANDORF E, STRAUSS D, et al. Treatment Trends and Outcomes for Patients With Lymph Node-Positive Cancer of the Penis [J]. JAMA Oncol,2018,4(5): 643- 649. 

[29] LUGHEZZANI G,CATANZARO M,TORELLI T, et al. The relationship between characteristics of inguinal lymph nodes and pelvic lymph node involvement in penile squamous cell carcinoma: a single institution experience [J]. J Urol, 2014,191(4):977-982. 

[30] GRAAFLAND NM, VAN BOVEN HH, VAN WERKHOVEN E,et al. Prognostic significance of extranodal extension in patients with pathological node positive penile carcinoma [J]. J Urol, 2010,184(4): 1347-1353. 

[31] NCCN Guidelines Office. NCCN Clinical Practice Guidelines in Oncology -PenileCancer [J/OL].(2022-6-10)[2022-6- 10]. http://www.nccn.org/guideline/Penile cancer/ 

[32] GRAAFLAND NM,MOONEN LM,VAN BOVEN HH, et al. Inguinal recurrence following therapeutic lymphadenectomy for node positive penile carcinoma: outcome and implications for management [J]. J Urol,2011,185(3):888-893. 

[33] BAUMGARTEN AS,ALHAMMALI E, HAKKY TS, et al. Salvage surgical resection for isolated locally recurrent inguinal lymph node metastasis of penile cancer: international study collaboration [J]. J Urol,2014,192(3): 760-764. 

[34] TANG DH, CHIPOLLINI J, SPIESS PE.Postchemotherapy lymph node dissection for isolated retroperitoneal nodal recurrences for penile cancer: Is cure possible in highly selected cases?[J]. Urol Oncol, 2018,36(1): 1-3. 

[35] SINGH A,JAIPURIA J,GOEL A,et al. Comparing Outcomes of Robotic and Open Inguinal Lymph Node Dissection in Patients with Carcinoma of the Penis [J]. J Urol,2018,199(6): 1518-1525.

[36] KOIFMAN L,HAMPL D,KOIFMAN N,et al. Radical open inguinal lymphadenectomy for penile carcinoma: surgical technique, early complications and late outcomes [J]. J Urol, 2013,190(6): 2086-2092. 

[37] GOPMAN JM,DJAJADININGRAT RS,BAUMGARTEN AS,et al. Predicting postoperative complications of inguinal lymph node dissection for penile cancer in an international multicentre cohort [J]. BJU Int,2015,116(2): 196-201. 

[38] STUIVER MM,DJAJADININGRAT RS,GRAAFLAND NM,et al. Early wound complications after inguinal lymphadenectomy in penile cancer: a historical cohort study and risk-factor analysis [J]. Eur Urol, 2013,64(3): 486-492. 

[39] SPIESS PE,HERNANDEZ MS,PETTAWAY CA. Contemporary inguinal lymph node dissection: minimizing complications [J]. World J Urol, 2009,27(2):205-212. 

[40] WELDRICK C,BASHAR K,O'SULLIVAN TA,et al. A comparison of fibrin sealant versus standard closure in the reduction of postoperative morbidity after groin dissection: A systematic review and meta- analysis [J]. Eur J Surg Oncol, 2014,40(11): 1391-1398. 

[41] TSUDA N,USHIJIMA K, KAWANO K,et al.Prevention of lymphocele development in gynecologic cancers by the electrothermal bipolar vessel sealing device [J]. J Gynecol Oncol,2014,25(3): 229-235. 

[42] ADWANI A,EBBS SR. Ultracision reduces acute blood loss but not seroma formation after mastectomy and axillary dissection: a pilot study [J]. Int J Clin Pract,2006,60(5): 562-564. 

[43] ZHANG X, SHENG X, NIU J, et al. Sparing of saphenous vein during inguinal lymphadenectomy for vulval malignancies [J]. Gynecol Oncol, 2007,105(3):722-726. 

[44] FANKHAUSER CD,AYRES BE, ISSA A,et al.Practice Patterns Among Penile Cancer Surgeons Performing Dynamic Sentinel Lymph Node Biopsy and Radical Inguinal Lymph Node Dissection in Men with Penile Cancer: A eUROGEN Survey [J]. Eur Urol Open Sci,2021,24:39-42. 

[45] OTTENHOF SR,LEONE A,DJAJADININGRAT RS, et al. Surgical and Oncological Outcomes in Patients After Vascularised Flap Reconstruction for Locoregionally Advanced Penile Cancer [J]. Eur Urol Focus, 2019,5(5): 867-874. 

[46] QI F,GU J, SHI Y. Difficult groin reconstruction using contralateral rectus abdominis myocutaneous flap [J]. Plast Reconstr Surg, 2008, 121(3): 147e-148e. 

[47] KHARADJIAN TB,MATIN SF,PETTAWAY CA.Early experience of robotic-assisted inguinal lymphadenectomy: review of surgical outcomes relative to alternative approaches [J]. Curr Urol Rep, 2014, 15(6): 412.

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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