阴茎癌腹股沟淋巴结清扫术中保留大隐静脉能否减少术后并发症的系统评价

摘要

Objective To explore whether preserving the great saphenous vein can reduce the postoperative complications in inguinal lymphadenectomy for penile cancer. Methods The litera-ture of penile cancer with inguinal lymph node dissection was searched by electronic databases such as Chinese Knowledge Network,Wanfang,Weipu,Chinese Biomedical Literature Database,Web of Science,PubMed and Cochrane Library.Search time ranged from the building to April 1,2017.Two researchers independently crossed the screening and extracted the literature,and the third researcher conducted a comparison of the results. Results A total of 39 manuscripts were included in the standard.There were 1 2 manuscripts which involved open groin lymph node dissection group.In these groups,there were 7 manuscripts which involved retaining the great saphenous vein and 2 man-uscripts which involved resection of the great saphenous vein.There were 3 manuscripts which in-volved both retaining the great saphenous vein and resection of the great saphenous vein.There were 27 manuscripts which involved laparoscopic inguinal lymph node dissection group.In those groups, there were 8 manuscripts which involved retaining the great saphenous vein and 1 8 manuscripts which involved resection of the great saphenous vein.Only one manuscript involved both retaining the great saphenous vein and resection of the great saphenous vein.In the case of open inguinal lymph node dissection,there was significant statistical difference in the rate of incision infection,the rate of flap necrosis,the incidence of lymphedema,the rate of seroma and the incidence of lower extremity edema between patients with retaining the great saphenous vein and without retaining the great saphenous vein(P<0.05).In the case of laparoscopic inguinal lymph node dissection,there was also statis-tically significant difference in the rate of incision infection,the incidence of seroma,and the incidence of lower extremity ede-ma (P<0.05). Conclusions Both in open and laparoscopic inguinal lymph node dissection,retention of the great saphenous vein is superior to non- retention in reducing the incidence of postoperative complications.%目的 探讨阴茎癌腹股沟淋巴结清扫术中保留大隐静脉能否减少术后并发症的发生.方法 在中国知网、万方、维普、中国生物医学文献数据库、Web of Science、PubMed、Co-chrane Library等电子数据库中进行阴茎癌腹股沟淋巴结清扫术相关文献检索,检索时限从建库至2017年4月1日.由2名研究者独立交叉阅读筛选及提取文献信息,第3名研究员对结果进行对比核查.结果 纳入符合标准的文献共39篇.开放腹股沟淋巴结清扫术组12篇(其中单纯保留大隐静脉组7篇,单纯切除大隐静脉组2篇,有3篇文献同时对比保留大隐静脉组及切除大隐静脉组),腹腔镜下腹股沟淋巴结清扫术组27篇(其中单纯保留大隐静脉组8篇,单纯切除大隐静脉组18篇,有1篇文献同时对比保留大隐静脉组及切除大隐静脉组).保留大隐静脉/不保留大隐静脉的开放腹股沟淋巴结清扫术病例的切口感染率、皮瓣坏死率、淋巴肿发生率、血清肿发生率、下肢水肿发生率差异均有统计学意义(P<0.05).保留大隐静脉/不保留大隐静脉的腹腔镜下腹股沟淋巴结清扫术病例的切口感染率、血清肿发生率、下肢水肿发生率差异亦有统计学意义(P<0.05).结论 无论在开放或是腹腔镜腹股沟淋巴结清扫术中,保留大隐静脉相对于不保留者能显著减少术后并发症的发生.