VEIL-H与OPL在外阴癌手术治疗中的对比性研究
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摘要
目的探讨腹腔镜下腹股沟淋巴结清扫术(video endoscopic inguinal lymphadenectomy, VEIL)在外阴癌根治术中的应用价值,并与传统开放性腹股沟淋巴结清扫术(open lymphadenectomy, OPL)进行比较。
资料与方法回顾性分析2009年8月至2012年12月在南方医科大学珠江医院和广州医学院第三附属医院等七家医院共24例外阴癌患者,其中15例外阴癌患者(FIGO2009分期ⅠB期8例、Ⅱ期4例、ⅢA期2例和ⅠA期行单纯外阴切除术后局部复发1例)进行了经下腹部皮下通路的腹股沟淋巴结清扫术(video endoscopic inguinal lymphadenectomy via the hypogastric subcutous approach, VEIL-H)及广泛外阴切除术(radical vulvarectomy, RV),列为VEIL-H组；另9例患者施行了开放性腹股沟淋巴结清扫术(OPL)及广泛外阴切除术(RV)(FIGO2009分期ⅠB期4例、Ⅱ期2例、ⅢA期1例、ⅢB期1例及ⅣA期1例),列为OPL组。所有患者均经组织病理学检查确诊。VEIL-H组和OPL组的年龄分别为(51.87±12.26岁和52.444±13.33岁,F=1.487,t=-0.199,P=0.843),分别比较各组手术时间、术中出血量、术中及术后并发症发生率、术后平均住院天数、复发转移情况及随访时间,用windows下的SPSS20.0中秩和检验和独立样本T检验对其结果进行比较分析。
结果VEIL-H组和OPL组的所有患者均成功进行了腹股沟淋巴结切除术和广泛外阴切除术。VEIL-H组与OPL组相比较,在外阴切除时间(50.40±±7.35分钟和48.11±7.24分钟,F=0.030,t=-1.055,P=0.298)、腹股沟浅淋巴结清扫时间(53.23±10.85分钟和47.39±8.30分钟,F=0.866,t=-1.964,P=0.056)、腹股沟深淋巴结清扫时间(27.57±8.32分钟和31.11±6.48分钟,F=0.037,t=1.546,P=0.129)、总手术时间(131.20±17.43分钟和126.61±11.57分钟,F=2.821,t=-0.991,P=0.327)、腹股沟浅淋巴结切除数目(5.00±1.44个和4.67±1.14个,F=1.487,t=-0.199,P=0.843)、腹股沟深淋巴结切除数目(3.07±0.69个和2.89±0.68个,F=0.001,t=-0.869,P=0.389)、外阴切除出血量(77.0±12.58m1和80.56±-11.23ml,F=0.442,t=0.986,P=0.329)等方面差异无统计学意义(P>0.05)；而在腹股沟浅淋巴结清扫出血量(2.90±1.27ml和23.89±6.54ml,F=37.610,t=17.157,P=0.000)、腹股沟深淋巴结清扫出血量(2.70±1.32ml和3.61±1.38ml,F=0.039,t=2.281,P=0.027)、术后住院天数(10.80±3.47天和24.33±5.68天,F=3.223,t=0.079,P=0.000)、术后总并发症的发生率(16.7%和77.7%,F=7.274,t=3.650,P=0.001)等方面差异具有统计学意义(P<0.05)。VEIL-H组中有一例患者术中一枚腹股沟深淋巴结术中冰冻结果阳性,加行了盆腔淋巴结切除术(LPP)；有3例患者术后常规病理提示5枚腹股沟淋巴结(其中,腹股沟浅淋巴结共4枚,腹股沟深淋巴结1枚)阳性,加行放疗治疗；另有3例患者进行了术后辅助化疗治疗；有2例患者出现术后尿潴留,在术后第7天拔出尿管后膀胱残余尿量仍超过150m1,行中医治疗后痊愈；15例患者中有3例发生非致命性术后并发症(发生率为16.7%),其中腹股沟淋巴囊肿2例,淋巴渗漏1例,外阴伤口延期愈合1例。2例腹股沟淋巴囊肿患者中,1例为术后4周出现左侧腹股沟区域淋巴囊肿(大小约为4cm×4cmx3cm),经B超引导下穿刺抽吸并加压包扎后痊愈；另1例患者右侧腹股沟淋巴囊肿大小3×3×2cm,经芒硝外敷等保守治疗2周后消失。淋巴渗漏的1例患者为术后第3周出现左侧腹股沟引流口淋巴渗漏,渗漏量最多时每天30m1,经芒硝外敷、加压包扎等治疗10天后痊愈。OPL组中所有患者术中冰冻结果未显示腹股沟淋巴结阳性,术后有4例患者单侧腹股沟伤口感染,伤口感染发生率44.4%(4/9),其中2例需行伤口二期缝合；有3例患者发生双侧腹股沟伤口疤痕挛缩,发生率为33.3%,出现轻微下肢活动障碍；另有2例患者术后5天出现下肢水肿,发生率为22.2%(2/9),经利尿、补充白蛋白、穿戴弹力袜等治疗后水肿于2月后消退。
结论与传统开放性腹股沟淋巴结清扫术相比,VEIL-H联合RV在外阴癌手术治疗中是安全可行的,VEIL-H不仅具有腹腔镜微创的优势,避免了传统外阴癌根治术的腹股沟大切口,可作为外阴癌腹股沟淋巴结清扫的新手术方式,同时对于合并盆腔疾病需同时行盆腔手术操作时可在原手术操作孔进行,无需再重新进行打孔。但由于本研究病例数有限,随访时间相对较短,其远期治疗效果还需要更长时间的临床观察。
Objective To evaluate the feasibility and safety of the application of video endoscopic inguinal lymphadenectomy via hypogastric subcutous approach (VEIL-H) in the treatment for the vulvar carcinoma, and to compare with traditional open inguinal lymphadenectomy.
Methods From August2009to December2012, all of24patients were analyzed retrospectively in seven hospitals of Zhujiang hospital, The Third Affiliated Hospital of Guangzhou Medical College, etc.15patients with vulvar cancer (8stage Ⅰ B,4Ⅱ stage,2ⅢA stage and1ⅠA stage with local recurrence after local excision in FIGO2009) who underwent VEIL-H were treated as group VEIL-H and9patients (4stage Ⅰ B,2Ⅱ stage,1ⅢA stage,1ⅢB stage and1IVA stage in FIGO2009) who underwent OPL (open inguinal lymphadenectomy, OPL) combined with radical vulvectomy were treated as group OPL. The age in group VEIL-H and OPL were (51.87±12.26years and52.44±13.33years, F=1.487, t=0.199, P=0.843). The statistics of operative time, intraoperative blood loss, intraoperative incidence, postoperative complications, postoperative average hospital stay, recurrence and follow-up time, et al were analyzed with Independent_Samples T-Test and rank-sum test in SPSS20.0for windows.
Results All24patients in group VEIL-H and OPL were successfully received inguinal lymphadenectomy combined with radical vulvectomy and all of patients in two groups successfully spared saphenous vein. The comparation between group VEIL-H and OPL, there were no significant differences in time of vulvar resection(50.40±7.35min and48.11±7.24min,F=0.030, t=-1.055, P=0.298), superficial inguinal lymph node dissection(53.23±10.85min and47.39±8.30min,F=0.866, t=-1.964, P=0.056) and deep inguinal lymph node dissection(27.57±8.32min and31.11±6.48min, F=0.037, t=1.546, P=0.129), total operative time(131.20±17.43min and126.61±11.57min, F=2.821, t=-0.991, P=0.327), the number of superficial inguinal lymph node excision(5.00±1.44and4.67±1.14, F=1.487, t=0.199, P=0.843), deep inguinal lymph node excision number(3.07±0.69and2.89±0.68, F=0.001, t=-0.869, P=0.389), the blood loss in radical vulvectomy(77.0±12.58ml and80.56±11.23ml, F=0.442, t=0.986, P=0.329)(P>0.05). But the comparation between group VEIL-H and OPL, there were significant differences in superficial inguinal lymph node dissection hemorrhage(2.90±1.27ml and23.89±6.54ml, F=37.610, t=17.157, P=0.000), the amount of bleeding in deep inguinal lymph node dissection(2.70±1.32ml and3.61±1.38ml, F=0.039, t=2.281, P=0.027), postoperative hospital stay(10.80±3.47days and24.33±5.68days, F=3.223, t=0.079, P=0.000), postoperative complication rate(16.7%and77.7%, F=7.274, t=3.650, P=0.001)(P<0.05). A deep inguinal lymph node frozen results was positive in group VEIL-H, laparoscopic pelvic lymphadenectomy (LPL) was performed. In group VEIL-H,3patients with5positive inguinal lymph nodes received radiation therapy after operation; a total of6patients underwent postoperative radiotherapy or chemotherapy;2patients with more residual urine (＞150ml) recovered for two weeks' acupuncture after the consultation of Department of traditional Chinese medicine;5of30lower limbs has postoperative complications(the rate of incidence16.7%), including2cases of unilateral inguinal lymph cyst,1case of local skin infection,1case of vulva healing,1case of lymph leakage,1case of wound dehiscence that recovered after treatment in Orthopedics;1patient suffered mild infected local wound, which improved with local treatment;2patients had left inguinal lymph cyst(4cm×4cm×3cm) on the postoperative week4,, which healed with the aspiration guided by B ultrasound and local dressing with pressure;1patient suffered lymph leakage on left groin3weeks after the surgery, which was treated by mount nitrate and recovered; no other complications occurred in the rest patients. In group OPL, there were no intraoperative frozen section results of deep inguinal lymph node positive; the total incidence rate of postoperative complications was77.7%,4patients had unilateral inguinal wound infection(the incidence rate was44.4%), which healed with secondary suture after the consultations of Department of Dermatology and plastic surgery;3cases of patients with bilateral inguinal scar contracture, the incidence rate was33.3%, resulting in lower limb dysfunction;2cases of patients resulted in lower extremity edema(the incidence rate22.2%), which was gone2months later after adopting the elastic stockings, diuretics, complementing albumin.
Conclusions Compared to OPL, VEIL-H combined with RV is safe and feasible in the treatment of vulvar cancer. It has the minimally invasive advantage, avoiding the long inguinal incision of traditional open inguinal lymphadenectomy in the treatment of vulva cancer. And it can be an alternative method of inguinal lymphadenectomy in the treatment of vulvar cancer. Future studies should include the bilateral procedure, longer term follow-up and a greater number of patients.
资料与方法回顾性分析2009年8月至2012年12月在南方医科大学珠江医院和广州医学院第三附属医院等七家医院共24例外阴癌患者,其中15例外阴癌患者(FIGO2009分期ⅠB期8例、Ⅱ期4例、ⅢA期2例和ⅠA期行单纯外阴切除术后局部复发1例)进行了经下腹部皮下通路的腹股沟淋巴结清扫术(video endoscopic inguinal lymphadenectomy via the hypogastric subcutous approach, VEIL-H)及广泛外阴切除术(radical vulvarectomy, RV),列为VEIL-H组；另9例患者施行了开放性腹股沟淋巴结清扫术(OPL)及广泛外阴切除术(RV)(FIGO2009分期ⅠB期4例、Ⅱ期2例、ⅢA期1例、ⅢB期1例及ⅣA期1例),列为OPL组。所有患者均经组织病理学检查确诊。VEIL-H组和OPL组的年龄分别为(51.87±12.26岁和52.444±13.33岁,F=1.487,t=-0.199,P=0.843),分别比较各组手术时间、术中出血量、术中及术后并发症发生率、术后平均住院天数、复发转移情况及随访时间,用windows下的SPSS20.0中秩和检验和独立样本T检验对其结果进行比较分析。
结果VEIL-H组和OPL组的所有患者均成功进行了腹股沟淋巴结切除术和广泛外阴切除术。VEIL-H组与OPL组相比较,在外阴切除时间(50.40±±7.35分钟和48.11±7.24分钟,F=0.030,t=-1.055,P=0.298)、腹股沟浅淋巴结清扫时间(53.23±10.85分钟和47.39±8.30分钟,F=0.866,t=-1.964,P=0.056)、腹股沟深淋巴结清扫时间(27.57±8.32分钟和31.11±6.48分钟,F=0.037,t=1.546,P=0.129)、总手术时间(131.20±17.43分钟和126.61±11.57分钟,F=2.821,t=-0.991,P=0.327)、腹股沟浅淋巴结切除数目(5.00±1.44个和4.67±1.14个,F=1.487,t=-0.199,P=0.843)、腹股沟深淋巴结切除数目(3.07±0.69个和2.89±0.68个,F=0.001,t=-0.869,P=0.389)、外阴切除出血量(77.0±12.58m1和80.56±-11.23ml,F=0.442,t=0.986,P=0.329)等方面差异无统计学意义(P>0.05)；而在腹股沟浅淋巴结清扫出血量(2.90±1.27ml和23.89±6.54ml,F=37.610,t=17.157,P=0.000)、腹股沟深淋巴结清扫出血量(2.70±1.32ml和3.61±1.38ml,F=0.039,t=2.281,P=0.027)、术后住院天数(10.80±3.47天和24.33±5.68天,F=3.223,t=0.079,P=0.000)、术后总并发症的发生率(16.7%和77.7%,F=7.274,t=3.650,P=0.001)等方面差异具有统计学意义(P<0.05)。VEIL-H组中有一例患者术中一枚腹股沟深淋巴结术中冰冻结果阳性,加行了盆腔淋巴结切除术(LPP)；有3例患者术后常规病理提示5枚腹股沟淋巴结(其中,腹股沟浅淋巴结共4枚,腹股沟深淋巴结1枚)阳性,加行放疗治疗；另有3例患者进行了术后辅助化疗治疗；有2例患者出现术后尿潴留,在术后第7天拔出尿管后膀胱残余尿量仍超过150m1,行中医治疗后痊愈；15例患者中有3例发生非致命性术后并发症(发生率为16.7%),其中腹股沟淋巴囊肿2例,淋巴渗漏1例,外阴伤口延期愈合1例。2例腹股沟淋巴囊肿患者中,1例为术后4周出现左侧腹股沟区域淋巴囊肿(大小约为4cm×4cmx3cm),经B超引导下穿刺抽吸并加压包扎后痊愈；另1例患者右侧腹股沟淋巴囊肿大小3×3×2cm,经芒硝外敷等保守治疗2周后消失。淋巴渗漏的1例患者为术后第3周出现左侧腹股沟引流口淋巴渗漏,渗漏量最多时每天30m1,经芒硝外敷、加压包扎等治疗10天后痊愈。OPL组中所有患者术中冰冻结果未显示腹股沟淋巴结阳性,术后有4例患者单侧腹股沟伤口感染,伤口感染发生率44.4%(4/9),其中2例需行伤口二期缝合；有3例患者发生双侧腹股沟伤口疤痕挛缩,发生率为33.3%,出现轻微下肢活动障碍；另有2例患者术后5天出现下肢水肿,发生率为22.2%(2/9),经利尿、补充白蛋白、穿戴弹力袜等治疗后水肿于2月后消退。
结论与传统开放性腹股沟淋巴结清扫术相比,VEIL-H联合RV在外阴癌手术治疗中是安全可行的,VEIL-H不仅具有腹腔镜微创的优势,避免了传统外阴癌根治术的腹股沟大切口,可作为外阴癌腹股沟淋巴结清扫的新手术方式,同时对于合并盆腔疾病需同时行盆腔手术操作时可在原手术操作孔进行,无需再重新进行打孔。但由于本研究病例数有限,随访时间相对较短,其远期治疗效果还需要更长时间的临床观察。
Objective To evaluate the feasibility and safety of the application of video endoscopic inguinal lymphadenectomy via hypogastric subcutous approach (VEIL-H) in the treatment for the vulvar carcinoma, and to compare with traditional open inguinal lymphadenectomy.
Methods From August2009to December2012, all of24patients were analyzed retrospectively in seven hospitals of Zhujiang hospital, The Third Affiliated Hospital of Guangzhou Medical College, etc.15patients with vulvar cancer (8stage Ⅰ B,4Ⅱ stage,2ⅢA stage and1ⅠA stage with local recurrence after local excision in FIGO2009) who underwent VEIL-H were treated as group VEIL-H and9patients (4stage Ⅰ B,2Ⅱ stage,1ⅢA stage,1ⅢB stage and1IVA stage in FIGO2009) who underwent OPL (open inguinal lymphadenectomy, OPL) combined with radical vulvectomy were treated as group OPL. The age in group VEIL-H and OPL were (51.87±12.26years and52.44±13.33years, F=1.487, t=0.199, P=0.843). The statistics of operative time, intraoperative blood loss, intraoperative incidence, postoperative complications, postoperative average hospital stay, recurrence and follow-up time, et al were analyzed with Independent_Samples T-Test and rank-sum test in SPSS20.0for windows.
Results All24patients in group VEIL-H and OPL were successfully received inguinal lymphadenectomy combined with radical vulvectomy and all of patients in two groups successfully spared saphenous vein. The comparation between group VEIL-H and OPL, there were no significant differences in time of vulvar resection(50.40±7.35min and48.11±7.24min,F=0.030, t=-1.055, P=0.298), superficial inguinal lymph node dissection(53.23±10.85min and47.39±8.30min,F=0.866, t=-1.964, P=0.056) and deep inguinal lymph node dissection(27.57±8.32min and31.11±6.48min, F=0.037, t=1.546, P=0.129), total operative time(131.20±17.43min and126.61±11.57min, F=2.821, t=-0.991, P=0.327), the number of superficial inguinal lymph node excision(5.00±1.44and4.67±1.14, F=1.487, t=0.199, P=0.843), deep inguinal lymph node excision number(3.07±0.69and2.89±0.68, F=0.001, t=-0.869, P=0.389), the blood loss in radical vulvectomy(77.0±12.58ml and80.56±11.23ml, F=0.442, t=0.986, P=0.329)(P>0.05). But the comparation between group VEIL-H and OPL, there were significant differences in superficial inguinal lymph node dissection hemorrhage(2.90±1.27ml and23.89±6.54ml, F=37.610, t=17.157, P=0.000), the amount of bleeding in deep inguinal lymph node dissection(2.70±1.32ml and3.61±1.38ml, F=0.039, t=2.281, P=0.027), postoperative hospital stay(10.80±3.47days and24.33±5.68days, F=3.223, t=0.079, P=0.000), postoperative complication rate(16.7%and77.7%, F=7.274, t=3.650, P=0.001)(P<0.05). A deep inguinal lymph node frozen results was positive in group VEIL-H, laparoscopic pelvic lymphadenectomy (LPL) was performed. In group VEIL-H,3patients with5positive inguinal lymph nodes received radiation therapy after operation; a total of6patients underwent postoperative radiotherapy or chemotherapy;2patients with more residual urine (＞150ml) recovered for two weeks' acupuncture after the consultation of Department of traditional Chinese medicine;5of30lower limbs has postoperative complications(the rate of incidence16.7%), including2cases of unilateral inguinal lymph cyst,1case of local skin infection,1case of vulva healing,1case of lymph leakage,1case of wound dehiscence that recovered after treatment in Orthopedics;1patient suffered mild infected local wound, which improved with local treatment;2patients had left inguinal lymph cyst(4cm×4cm×3cm) on the postoperative week4,, which healed with the aspiration guided by B ultrasound and local dressing with pressure;1patient suffered lymph leakage on left groin3weeks after the surgery, which was treated by mount nitrate and recovered; no other complications occurred in the rest patients. In group OPL, there were no intraoperative frozen section results of deep inguinal lymph node positive; the total incidence rate of postoperative complications was77.7%,4patients had unilateral inguinal wound infection(the incidence rate was44.4%), which healed with secondary suture after the consultations of Department of Dermatology and plastic surgery;3cases of patients with bilateral inguinal scar contracture, the incidence rate was33.3%, resulting in lower limb dysfunction;2cases of patients resulted in lower extremity edema(the incidence rate22.2%), which was gone2months later after adopting the elastic stockings, diuretics, complementing albumin.
Conclusions Compared to OPL, VEIL-H combined with RV is safe and feasible in the treatment of vulvar cancer. It has the minimally invasive advantage, avoiding the long inguinal incision of traditional open inguinal lymphadenectomy in the treatment of vulva cancer. And it can be an alternative method of inguinal lymphadenectomy in the treatment of vulvar cancer. Future studies should include the bilateral procedure, longer term follow-up and a greater number of patients.
引文
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[11]葛崇华,李庭芳.外阴癌病因的研究进展.国外医学：妇产科学分册,2005,32(2)：116-116.
[12]Engelman DE, Andrade LA, Vassallo J. Human papillomavirus infection and p53 protein expression in vulvar intraepithelial neoplasia and invasive squamous cell carcinoma. Braz J Med Biol Res,2003,36(9):1159-1165.
[13]Adamek K, Szczudrawa A, Basta A. [Coexistence of VIN and vulvar invasive cancer with intraepithelial neoplasia and invasive carcinoma of the cervix and/or vagina, and HPV infection of the low female genital tract]. Ginekol Pol,2003,74(9):657-661.
[14]Rolfe KJ, MacLean AB, Crow JC, et al. TP53 mutations in vulval lichen sclerosus adjacent to squamous cell carcinoma of the vulva. Br J Cancer, 2003,89(12):2249-2253.
[15]Conley LJ, Ellerbrock TV, Bush TJ, et al. HIV-1 infection and risk of vulvovaginal and perianal condylomata acuminata and intraepithelial neoplasia:a prospective cohort study. Lancet,2002,359(9301):108-113.
[16]Giaquinto C, Del Mistro A, De Rossi A, et al. Vulvar carcinoma in a 12-year-old girl with vertically acquired human immunodeficiency virus infection. Pediatrics,2000,106(4):E57.
[17]李力.外阴癌的放射治疗.中国实用妇科与产科杂志,2006,22(8)：571-573.
[18]Mutch DG. The new FIGO staging system for cancers of the vulva, cervix, endometrium and sarcomas. Gynecol Oncol,2009,115(3):325-328.
[19]林仲秋,吴珠娜.FIGO 2009外阴癌,宫颈癌和子宫内膜癌新分期解读.国际妇产科学杂志,2009,36(5)：411-412.
[20]Fuh KC, Berek JS. Current management of vulvar cancer. Hematol Oncol Clin North Am,2012,26(1):45-62.
[21]PODRATZ KC, WILLIAMS TJ, TAYLOR WF. Carcinoma of the vulva: analysis of treatment and survival. Obstetrics & Gynecology,1983,61(1): 63-74.
[22]Burger MP, Hollema H, Emanuels AG, et al. The importance of the groin node status for the survival of T1 and T2 vulval carcinoma patients. Gynecol Oncol,1995,57(3):327-334.
[23]De Hullu JA, Hollema H, Lolkema S, et al. Vulvar carcinoma. The price of less radical surgery. Cancer,2002,95(11):2331-2338.
[24]Durdevic S, Segedi D. Block dissection of inguinofemoral lymph nodes using separate "S" incision in surgical treatment of vulvar carcinoma. Med Pregl,2004,57(7-8):343-348.
[25]Dargent PMSSMRD. Inguinoscopy or Video-Endoscopic Inguinal Lymphnode Dissection. the Trocar website,2002,02/11/2002
[26]Tobias-Machado M, Tavares A, Molina WR, Jr., et al. Video endoscopic inguinal lymphadenectomy (VEIL):minimally invasive resection of inguinal lymph nodes. Int Braz J Urol,2006,32(3):316-321.
[27]Manavi M, Berger A, Kucera E, et al. Does T1, N0-1 vulvar cancer treated by vulvectomy but not lymphadenectomy need inguinofemoral radiation? Int J Radiat Oncol Biol Phys,1997,38(4):749-753.
[28]Ghurani GB, Penalver MA. An update on vulvar cancer. Am J Obstet Gynecol,2001,185(2):294-299.
[29]吕平,刘芳,戚昭恩.腹腔镜外科百年发展史.中华医史杂志,2001, 31(4):29.
[30]East T, Oram S. The heart in scleroderma. British heart journal,1947,9(3): 167.
[31]郎景和,冷金花.妇科腹腔镜的现状及展望.实用妇产科杂志,2002,18(2)：67-70.
[32]Bishoff J, Basler J, Teichman J, et al. Endoscopic subcutaneous modified inguinal lymph node dissection (ESMIL) for squamous cell carcinoma of the penis. J Urol,2003,169(4):78.
[33]Tobias-Machado M, Tavares A, Silva MNR, et al. Can video endoscopic inguinal lymphadenectomy achieve a lower morbidity than open lymph node dissection in penile cancer patients? Journal of Endourology,2008,22(8): 1687-1692.
[34]Tobias-Machado M, Tavares A, Silva MN, et al. Can video endoscopic inguinal lymphadenectomy achieve a lower morbidity than open lymph node dissection in penile cancer patients? J Endourol,2008,22(8):1687-1691.
[35]Sarnaik AA, Puleo CA, Zager JS, et al. Limiting the morbidity of inguinal lymphadenectomy for metastatic melanoma. Cancer Control,2009,16(3): 240-247.
[36]Delman KA, Kooby DA, Rizzo M, et al. Initial experience with videoscopic inguinal lymphadenectomy. Ann Surg Oncol,2011,18(4):977-982.
[37]Hadway P, Smith Y, Corbishley C, et al. Evaluation of dynamic lymphoscintigraphy and sentinel lymph-node biopsy for detecting occult metastases in patients with penile squamous cell carcinoma. BJU international,2007,100(3):561-565.
[2]Levenback C, Morris M, Burke TW, et al. Groin dissection practices among gynecologic oncologists treating early vulvar cancer. Gynecologic oncology, 1996,62(1):73-77.
[3]De Hullu J, Oonk M, Ansink A, et al. Pitfalls in the sentinel lymph node procedure in vulvar cancer. Gynecologic oncology,2004,94(1):10-15.
[4]Taussig FJ. Cancer of the vulva:an analysis of 155 cases. Am J Obstet Gynecol,1940,40(764):79.
[5]Way S. The anatomy of the lymphatic drainage of the vulva and its influence on the radical operation for carcinoma. Ann R Coll Surg Engl,1948,3(4): 187-209.
[6]Podratz KC, Gaffey TA, Symmonds RE, et al. Melanoma of the vulva:an update. Gynecologic Oncology,1983,16(2):153-168.
[7]Hinten F, van den Einden LC, Hendriks JC, et al. Risk factors for short- and long-term complications after groin surgery in vulvar cancer. Br J Cancer, 2011,105(9):1279-1287.
[8]Machado MT TA, Molina Jr WR, Zambon JP,, Forsetto Jr P JR, Wroclawski ER. Comparative study between videoendoscopic radical inguinal lymphadenectomy(VEIL) and standard open lymphadenectomy for penile cancer:preliminary surgical and oncological results. Urology,2005, Abst 834: 226.
[9]Tobias-Machado M, Tavares A, Molina WR, Jr., et al. Video endoscopic inguinal lymphadenectomy (VEIL):initial case report and comparison with open radical procedure. Arch Esp Urol,2006,59(8):849-852.
[10]Josephson DY, Jacobsohn KM, Link BA, et al. Robotic-assisted endoscopic inguinal lymphadenectomy. Urology,2009,73(1):167-170; discussion 170-161.
[11]葛崇华,李庭芳.外阴癌病因的研究进展.国外医学：妇产科学分册,2005,32(2)：116-116.
[12]Engelman DE, Andrade LA, Vassallo J. Human papillomavirus infection and p53 protein expression in vulvar intraepithelial neoplasia and invasive squamous cell carcinoma. Braz J Med Biol Res,2003,36(9):1159-1165.
[13]Adamek K, Szczudrawa A, Basta A. [Coexistence of VIN and vulvar invasive cancer with intraepithelial neoplasia and invasive carcinoma of the cervix and/or vagina, and HPV infection of the low female genital tract]. Ginekol Pol,2003,74(9):657-661.
[14]Rolfe KJ, MacLean AB, Crow JC, et al. TP53 mutations in vulval lichen sclerosus adjacent to squamous cell carcinoma of the vulva. Br J Cancer, 2003,89(12):2249-2253.
[15]Conley LJ, Ellerbrock TV, Bush TJ, et al. HIV-1 infection and risk of vulvovaginal and perianal condylomata acuminata and intraepithelial neoplasia:a prospective cohort study. Lancet,2002,359(9301):108-113.
[16]Giaquinto C, Del Mistro A, De Rossi A, et al. Vulvar carcinoma in a 12-year-old girl with vertically acquired human immunodeficiency virus infection. Pediatrics,2000,106(4):E57.
[17]李力.外阴癌的放射治疗.中国实用妇科与产科杂志,2006,22(8)：571-573.
[18]Mutch DG. The new FIGO staging system for cancers of the vulva, cervix, endometrium and sarcomas. Gynecol Oncol,2009,115(3):325-328.
[19]林仲秋,吴珠娜.FIGO 2009外阴癌,宫颈癌和子宫内膜癌新分期解读.国际妇产科学杂志,2009,36(5)：411-412.
[20]Fuh KC, Berek JS. Current management of vulvar cancer. Hematol Oncol Clin North Am,2012,26(1):45-62.
[21]PODRATZ KC, WILLIAMS TJ, TAYLOR WF. Carcinoma of the vulva: analysis of treatment and survival. Obstetrics & Gynecology,1983,61(1): 63-74.
[22]Burger MP, Hollema H, Emanuels AG, et al. The importance of the groin node status for the survival of T1 and T2 vulval carcinoma patients. Gynecol Oncol,1995,57(3):327-334.
[23]De Hullu JA, Hollema H, Lolkema S, et al. Vulvar carcinoma. The price of less radical surgery. Cancer,2002,95(11):2331-2338.
[24]Durdevic S, Segedi D. Block dissection of inguinofemoral lymph nodes using separate "S" incision in surgical treatment of vulvar carcinoma. Med Pregl,2004,57(7-8):343-348.
[25]Dargent PMSSMRD. Inguinoscopy or Video-Endoscopic Inguinal Lymphnode Dissection. the Trocar website,2002,02/11/2002
[26]Tobias-Machado M, Tavares A, Molina WR, Jr., et al. Video endoscopic inguinal lymphadenectomy (VEIL):minimally invasive resection of inguinal lymph nodes. Int Braz J Urol,2006,32(3):316-321.
[27]Manavi M, Berger A, Kucera E, et al. Does T1, N0-1 vulvar cancer treated by vulvectomy but not lymphadenectomy need inguinofemoral radiation? Int J Radiat Oncol Biol Phys,1997,38(4):749-753.
[28]Ghurani GB, Penalver MA. An update on vulvar cancer. Am J Obstet Gynecol,2001,185(2):294-299.
[29]吕平,刘芳,戚昭恩.腹腔镜外科百年发展史.中华医史杂志,2001, 31(4):29.
[30]East T, Oram S. The heart in scleroderma. British heart journal,1947,9(3): 167.
[31]郎景和,冷金花.妇科腹腔镜的现状及展望.实用妇产科杂志,2002,18(2)：67-70.
[32]Bishoff J, Basler J, Teichman J, et al. Endoscopic subcutaneous modified inguinal lymph node dissection (ESMIL) for squamous cell carcinoma of the penis. J Urol,2003,169(4):78.
[33]Tobias-Machado M, Tavares A, Silva MNR, et al. Can video endoscopic inguinal lymphadenectomy achieve a lower morbidity than open lymph node dissection in penile cancer patients? Journal of Endourology,2008,22(8): 1687-1692.
[34]Tobias-Machado M, Tavares A, Silva MN, et al. Can video endoscopic inguinal lymphadenectomy achieve a lower morbidity than open lymph node dissection in penile cancer patients? J Endourol,2008,22(8):1687-1691.
[35]Sarnaik AA, Puleo CA, Zager JS, et al. Limiting the morbidity of inguinal lymphadenectomy for metastatic melanoma. Cancer Control,2009,16(3): 240-247.
[36]Delman KA, Kooby DA, Rizzo M, et al. Initial experience with videoscopic inguinal lymphadenectomy. Ann Surg Oncol,2011,18(4):977-982.
[37]Hadway P, Smith Y, Corbishley C, et al. Evaluation of dynamic lymphoscintigraphy and sentinel lymph-node biopsy for detecting occult metastases in patients with penile squamous cell carcinoma. BJU international,2007,100(3):561-565.