山东大学学报 (医学版) ›› 2021, Vol. 59 ›› Issue (9): 103-109.doi: 10.6040/j.issn.1671-7554.0.2021.1060
王沂峰,何丽清
WANG Yifeng, HE Liqing
摘要： 外阴癌是一种罕见的恶性肿瘤,近年来发病率逐步上升。早期外阴癌预后好,而晚期和复发性外阴癌则治疗效果不佳。外阴癌主要转移途径是通过局部浸润和淋巴转移,淋巴转移最先从外阴病灶流向腹股沟区。因此,对于早期外阴癌,主要治疗方法是原发性外阴肿瘤及腹股沟区淋巴结切除术。腹股沟淋巴结的状态是预测复发及生存的独立危险因素,并且决定是否需要增加辅助治疗。腹股沟区的手术很重要,但是各种术后并发症严重影响患者的生活质量,为此妇科医生也在不断改进手术方式。本文就外阴癌腹股沟淋巴结手术改进和创新中遇到的问题进行探讨。
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| [1] Siegel RL, Miller KD, Fuchs HE, et al. Cancer Statistics, 2021 [J]. CA Cancer J Clin, 2021, 71(1): 7-33. [2] Pleunis N, Schuurman MS, Van Rossum MM, et al. Rare vulvar malignancies; incidence, treatment and survival in the Netherlands [J]. Gynecol Oncol, 2016, 142(3): 440-445. [3] Hoang LN, Park KJ, Soslow RA, et al. Squamous precursor lesions of the vulva: current classification and diagnostic challenges [J]. Pathology, 2016, 48(4): 291-302. [4] Cohen PA, Anderson L, Eva L, et al. Clinical and molecular classification of vulvar squamous pre-cancers [J]. Int J gynecol Cancer, 2019, 29(4): 821-828. [5] De Sanjosé S, Alemany L, Ordi J, et al. Worldwide human papillomavirus genotype attribution in over 2000 cases of intraepithelial and invasive lesions of the vulva [J]. Eur J Cancer, 2013, 49(16): 3450-3461. [6] Hinten F, Molijn A, Eckhardt L, et al. Vulvar cancer: two pathways with different localization and prognosis [J]. Gynecol Oncol, 2018, 149(2): 310-317. [7] Halec G, Alemany L, Quiros B, et al. Biological relevance of human papillomaviruses in vulvar cancer [J]. Mod Pathol, 2017, 30(4): 549-562. [8] Gaarenstroom KN, Kenter GG, Trimbos JB, et al. Postoperative complications after vulvectomy and inguinofemoral lymphadenectomy using separate groin incisions [J]. Int J Gynecol Cancer, 2003, 13(4): 522-527. [9] Gadducci A, Cionini L, Romanini A, et al. Old and new perspectives in the management of high-risk, locally advanced or recurrent, and metastatic vulvar cancer [J]. Crit Rev Oncol Hematol, 2006, 60(3): 227-241. [10] Podratz KC, Symmonds RE, Taylor WF, et al. Carcinoma of the vulva: analysis of treatment and survival [J]. Obstet Gynecol, 1983, 61(1): 63-74. [11] Sedlis A, Homesley H, Bundy BN, et al. Positive groin lymph nodes in superficial squamous cell vulvar cancer. A Gynecologic Oncology Group Study [J]. Am J Obstet Gynecol, 1987, 156(5): 1159-1164. [12] Selman TJ, Luesley DM, Acheson N, et al. A systematic review of the accuracy of diagnostic tests for inguinal lymph node status in vulvar cancer [J]. Gynecol Oncol, 2005, 99(1): 206-214. [13] Oonk MHM, Hollema H, de Hullu JA, et al. Prediction of lymph node metastases in vulvar cancer: a review [J]. Int J Gynecol Cancer, 2006, 16(3): 963-971. [14] Mäkelä PJ, Leminen A, Kääriäinen M, et al. Pretreatment sonographic evaluation of inguinal lymph nodes in patients with vulvar malignancy [J]. J Ultrasound Med, 1993, 12(5): 255-258. [15] Abang Mohammed DK, Uberoi R, De B Lpoes A, et al. Inguinal node status by ultrasound in vulva cancer [J]. Gynecol Oncol, 2000, 77(1): 93-96. [16] Cohn DE, Dehdashti F, Gibb RK, et al. Prospective evaluation of positron emission tomography for the detection of groin node metastases from vulvar cancer [J]. Gynecol Oncol, 2002, 85(1): 179-184. [17] Pounds R, ONeill D, Subba K, et al. The role of preoperative computerized tomography(CT)scan of the pelvis and groin in the management of clinically early staged vulva squamous cell carcinoma [J]. Gynecol Oncol, 2020, 157(2): 444-449. [18] Aslam Sohaib SA, Richards PS, Ind T, et al. MR imaging of carcinoma of the vulva [J]. AJR Am J Roentgenol, 2002, 178(2): 373-377. [19] Sakae C, Yamaguchi K, Matsumura N, et al. Groin lymph node detection and sentinel lymph node biopsy in vulvar cancer [J]. J Gynecol Oncol, 2016, 27(6): e57. doi: 10.3802/jgo.2016.27.e57. [20] Bellin MF, Roy C, Kinkel K, et al. Lymph node metastases: safety and effectiveness of MR imaging with ultrasmall superparamagnetic iron oxide particles——initial clinical experience [J]. Radiology, 1998, 207(3): 799-808. [21] Sohaib SAA, Moskovic EC. Imaging in vulval cancer [J]. Best Pract Res Clin Obstet Gynaecol, 2003, 17(4): 543-556. [22] Angelico G, Santoro A, Inzani F, et al. Ultrasound-guided FNA cytology of groin lymph nodes improves the management of squamous cell carcinoma of the vulva: results from a comparative cytohistological study [J]. Cancer Cytopathol, 2019, 127(8): 514-520. [23] Moskovic EC, Shepherd JH, Barton DP, et al. The role of high resolution ultrasound with guided cytology of groin lymph nodes in the management of squamous cell carcinoma of the vulva: a pilot study [J]. Br J Obstet Gynaecol, 1999, 106(8): 863-867. [24] van der Velden K, Ansink A. Primary groin irradiation vs primary groin surgery for early vulvar cancer [J]. Cochrane Database Syst Rev, 2001(4): CD002224. doi: 10.1002/14651858.CD002224. [25] Hyde SE, Valmadre S, Hacker NF, et al. Squamous cell carcinoma of the vulva with bulky positive groin nodes-nodal debulking versus full groin dissection prior to radiation therapy [J]. Int J Gynecol Cancer, 2007, 17(1): 154-158. [26] Stecklein SR, Frumovitz M, Klopp AH, et al. Effectiveness of definitive radiotherapy for squamous cell carcinoma of the vulva with gross inguinal lymphadenopathy [J]. Gynecol Oncol, 2018, 148(3): 474-479. [27] Franklin EW, 3rd, Rutledge FD. Prognostic factors in epidermoid carcinoma of the vulva [J]. Obstet Gynecol, 1971, 37(6): 892-901. [28] Wharton JT, Gallager S, Rutledge FN. Microinvasive carcinoma of the vulva [J]. Am J Obstet Gynecol, 1974, 118(2): 159-162. [29] Parker RT, Duncan I, Rampone J, et al. Operative management of early invasive epidermoid carcinoma of the vulva [J]. Am J Obstet Gynecol, 1975, 123(4): 349-355. [30] Jafari K, Cartnick EN. Microinvasive squamous cell carcinoma of the vulva [J]. Gynecol Oncol, 1976, 4(2): 158-166. [31] Nakao CY, Nolan JF, Disaia PJ, et al. “Microinvasive” epidermoid carcinoma of the vulva with an unexpected natural history [J]. Am J Obstet Gynecol, 1974, 120(8): 1122-1123. [32] Dipaola GR, Gomez-Rueda N, Arrighi L. Relevance of microinvasion in carcinoma of the vulva [J]. Obstet Gynecol, 1975, 45(6): 647-649. [33] Disaia PJ, Creasman WT, Rich WM. An alternate approach to early cancer of the vulva [J]. Am J Obstet Gynecol, 1979, 133(7): 825-832. [34] Stehman FB, Bundy BN, Ball H, et al. Sites of failure and times to failure in carcinoma of the vulva treated conservatively: a Gynecologic Oncology Group study [J]. Am J Obstet Gynecol, 1996, 174(4): 1128-1132. [35] Homesley HD, Bundy BN, Sedlis A, et al. Prognostic factors for groin node metastasis in squamous cell carcinoma of the vulva(a Gynecologic Oncology Group study)[J]. Gynecol Oncol, 1993, 49(3): 279-283. [36] Hacker NF, Van der Velden J. Conservative management of early vulvar cancer [J]. Cancer, 1993, 71(4 Suppl): 1673-1677. [37] Iversen T, Aas M. Lymph drainage from the vulva [J]. Gynecol Oncol, 1983, 16(2): 179-189. [38] Hacker NF, Berek JS, Lagasse LD, et al. Individualization of treatment for stage I squamous cell vulvar carcinoma [J]. Obstet Gynecol, 1984, 63(2): 155-162. [39] Rutledge F, Smith JP, Franklin EW. Carcinoma of the vulva [J]. Am J Obstet Gynecol, 1970, 106(8): 1117-1130. [40] Magrina JF, Webb MJ, Gaffey TA, et al. Stage I squamous cell cancer of the vulva [J]. Am J Obstet Gynecol, 1979, 134(4): 453-459. [41] Monaghan JM, Hammond IG. Pelvic node dissection in the treatment of vulval carcinoma——is it necessary? [J]. Br J Obstet Gynaecol, 1984, 91(3): 270-274. [42] Hoffman JS, Kumar NB, Morley GW. Microinvasive squamous carcinoma of the vulva: search for a definition [J]. Obstet Gynecol, 1983, 61(5): 615-618. [43] Lingard D, Free K, Wright RG, et al. Invasive squamous cell carcinoma of the vulva: behaviour and results in the light of changing management regimens. A review of clinicohistological features predictive of regional lymph node involvement and local recurrence [J]. Aust N Z J Obstet Gynaecol, 1992, 32(2): 137-145. [44] Hacker NF, Leuchter RS, Berek JS, et al. Radical vulvectomy and bilateral inguinal lymphadenectomy through separate groin incisions [J]. Obstet Gynecol, 1981, 58(5): 574-579. [45] Heaps JM, Fu YS, Montz FJ, et al. Surgical-pathologic variables predictive of local recurrence in squamous cell carcinoma of the vulva [J]. Gynecol Oncol, 1990, 38(3): 309-314. [46] Helm CW, Hatch K, Austin JM, et al. A matched comparison of single and triple incision techniques for the surgical treatment of carcinoma of the vulva [J]. Gynecol Oncol, 1992, 46(2): 150-156. [47] Grimshaw RN, Murdoch JB, Monaghan JM. Radical vulvectomy and bilateral inguinal-femoral lymphadenectomy through separate incisions-experience with 100 cases [J]. Int J Gynecol Cancer, 1993, 3(1): 18-23. [48] Bertheuil N, Sulpice L, Levi Sandri GB, et al. Inguinal lymphadenectomy for stage III melanoma: a comparative study of two surgical approaches at the onset of lymphoedema [J]. Eur J Surg Oncol, 2015, 41(2): 215-219. [49] Tonouchi H, Ohmori Y, Kobayashi M, et al. Operative morbidity associated with groin dissections [J]. Surg Today, 2004, 34(5): 413-418. [50] Borgno G, Micheletti L, Barbero M, et al. Topographic distribution of groin lymph nodes. A study of 50 female cadavers [J]. J Reprod Med, 1990, 35(12): 1127-1129. [51] Nicklin JL, Hacker NF, Heintze SW, et al. An anatomical study of inguinal lymph node topography and clinical implications for the surgical management of vulval cancer [J]. Int J Gynecol Cancer, 1995, 5(2): 128-133. [52] Micheletti L, Preti M, Zola P, et al. A proposed glossary of terminology related to the surgical treatment of vulvar carcinoma [J]. Cancer, 1998, 83(7): 1369-1375. [53] Micheletti L, Levi AC, Bogliatto F, et al. Rationale and definition of the lateral extension of the inguinal lymphadenectomy for vulvar cancer derived from an embryological and anatomical study [J]. J Surg Oncol, 2002, 81(1): 19-24. [54] Micheletti L, Levi AC, Bogliatto F. Anatomosurgical implications derived from an embryological study of the Scarpas triangle with particular reference to groin lymphadenectomy [J]. Gynecol Oncol, 1998, 70(3): 358-364. [55] Micheletti L, Borgno G, Barbero M, et al. Deep femoral lymphadenectomy with preservation of the fascia lata. Preliminary report on 42 invasive vulvar carcinomas [J]. J Reprod Med, 1990, 35(12): 1130-1133. [56] Micheletti L, Bogliatto F, Massobrio M. Groin lymphadenectomy with preservation of femoral fascia: total inguinofemoral node dissection for treatment of vulvar carcinoma [J]. World J Surg, 2005, 29(10): 1268-1276. [57] Bell JG, Lea JS, Reid GC. Complete groin lymphadenectomy with preservation of the fascia lata in the treatment of vulvar carcinoma [J]. Gynecol Oncol, 2000, 77(2): 314-318. [58] Bishoff JB, Teichman JM, Thompson IM. Endoscopic subcutaneous modified inguinal lymph node dissection(ESMIL)for squamous cell carcinoma of the penis [J]. J Urology, 2003, 169(4): 78. [59] Xu H, Wang D, Wang Y, et al. Endoscopic inguinal lymphadenectomy with a novel abdominal approach to vulvar cancer: description of technique and surgical outcome [J]. J Minim Invasive Gynecol, 2011, 18(5): 644-650. [60] 崔曾营, 王沂峰, 陈高文, 等. 腹腔镜下腹股沟淋巴清扫术在外阴癌手术治疗中的应用 [J]. 中华医学杂志, 2013, 93(21): 1653-1656. CUI Zengying, WANG Yifeng, CHEN Gaowen, et al. Application of video endoscopic lymphadenectomy in radical vulvectomy for carcinoma [J]. National Medical Journal of China, 2013, 93(21): 1653-1656. [61] 陈高文, 王沂峰, 王颖, 等. 两种皮下通路腹腔镜腹股沟淋巴结清扫术在外阴癌治疗中的对比观察 [J]. 中华医学杂志, 2014, 94(1): 39-42. CHEN Gaowen, WANG Yifeng, WANG Ying, et al. Video endoscopic inguinal lymphadenectomy via hypogastric/limb subcutaneous approach for early-stage vulvar cancer [J]. National Medical Journal of China, 2014, 94(1): 39-42. [62] 陈高文, 王颖, 彭冬先, 等. 经下肢皮下通路的腹腔镜腹股沟淋巴结切除术在外阴癌治疗中的应用 [J]. 实用妇产科杂志, 2016, 32(6): 431-435. CHEN Gaowen, WANG Ying, PENG Dongxian, et al. Video endoscopic inguinal lymphadenectomy via the limb subcutaneous approach for the early-stage vulvar cancer: surgical technique and outcomes [J]. Journal of Practical Obstetrics and Gynecology, 2016, 32(6): 431-435. [63] Wang YF, Chen GW, Weng HN, et al. Surgical technique of video endoscopic inguinal lymphadenectomy via a hypogastric subcutaneous approach [J]. Chin Med J(Engl), 2013, 126(16): 3181-3183. [64] Zhang M, Chen L, Zhang X, et al. A comparative study of video endoscopic inguinal lymphadenectomy and conventional open inguinal lymphadenectomy for treating vulvar cancer [J]. Int J Gynecol Cancer, 2017, 27(9): 1983-1989. [65] Le A, Xiong J, Wang Z, et al. Endoscopy-assisted inguinal lymphadenectomy in vulvar cancer [J]. Arch Gynecol Obstet, 2018, 297(5): 1277-1283. [66] 王沂峰, 陈高文, 马颖, 等. 利用单切口行外阴恶性肿瘤广泛外阴切除及腹股沟淋巴结清扫术的探讨 [J]. 中华医学杂志, 2019, 99(31): 2450-2454. WANG Yifeng, CHEN Gaowen, MA Ying, et al. Radical vulvectomy and inguinal lymphadenectomy using a single incision for the treatment of vulvar malignancy [J]. National Medical Journal of China, 2019, 99(31): 2450-2454. [67] He L, Chen G, Li X, et al. Safety and feasibility of single-incision radical vulvectomy: a novel approach for the treatment of vulvar cancer [J]. Ann Transl Med, 2021, 9(4): 320. [68] Oonk MH, van Hemel BM, Hollema H, et al. Size of sentinel-node metastasis and chances of non-sentinel-node involvement and survival in early stage vulvar cancer: results from GROINSS-V, a multicentre observational study [J]. Lancet Oncol, 2010, 11(7): 646-652. [69] Levenback CF, Ali S, Coleman RL, et al. Lymphatic mapping and sentinel lymph node biopsy in women with squamous cell carcinoma of the vulva: a gynecologic oncology group study [J]. J Clin Oncol, 2012, 30(31): 3786-3791. [70] Covens A, Vella ET, Kennedy EB, et al. Sentinel lymph node biopsy in vulvar cancer: systematic review, meta-analysis and guideline recommendations [J]. Gynecol Oncol, 2015, 137(2): 351-361. [71] Siegenthaler F, Imboden S, Knabben L, et al. Exploratory study of the clinical value of near-infrared sentinel lymph node mapping with indocyanine green in vulvar cancer patients [J]. Front Oncol, 2021, 11: 652458. doi: 10.3389/fonc.2021.652458. [72] Sykes P, Eva L, van der Griend R, et al. Pathological process has a crucial role in sentinel node biopsy for vulvar cancer [J]. Gynecol Oncol, 2019, 153(2): 292-296. [73] Oonk MHM, Slomovitz B, Baldwin PJW, et al. Radiotherapy versus inguinofemoral lymphadenectomy as treatment for vulvar cancer patients with micrometastases in the sentinel node: results of GROINSS-V II [J]. J Clin Oncology, 2021: JCO2100006. doi: 10.1200/JCO.21.00006. |
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