| Objective:Comparative study of inguinal lymph node dissection in video endoscopic and open surgery for the surgical treatment of vulvar squamous cell carcinoma,analyse the clinical efficacy and economic index of vulvar squamous cell carcinoma by video endoscopic inguinal lymphadenectomy,evaluate its clinical value and scalability.Methods:A retrospective analysis from October 2011 to October 2016 in Yuncheng Central Hospital,Changzhi Medical College affiliated Heping Hospital,Shanxi Provincial Tumor Hospital from three hospitals in 39 cases of vulvar squamous cell carcinoma patients,including 15 patients(5 cases?A stage;5 cases?Bstage;1 cases?stage;4 cases?stage)underwent video endoscopic inguinal lymphadenectomy add radical vulvectomy were treated as the VEIL group;the remaining 24 patients(5 cases?A stage;7 cases?Bstage;7 cases?stage;4 cases ?stage;1 cases recurred after vulvar tumor resection)underwent open lymphadenectomy add radical vulvectomy operation,as the OPL group.All of the patients were diagnosed with vulvar squamous cell carcinoma after vulvar surgical resection or tumor resection.The patients age in VEIL group and OPL group were(58.20±7.18)years and(55.83±7.12)years;The height were(158.47±5.78)cm and(159.46±4.44)cm;The weight were(61.60±10.68)kg and(60.04±5.87)kg.A retrospective analysis of two patients with total hospitalization time,postoperative hospitalization time,operation time,intraoperative blood loss,number of lymph nodes dissection of left andright sides respectively,postoperative drainage tube duration,total hospitalization cost,operation fee,anesthetic fee,postoperative related costs,postoperative complications incidence,recurrence and metastasis and follow-up prognosis,et al.The data were analyzed by ?2 test and independent sample t-test in SPSS 19.0.Results:Two groups of patients were performed successfully inguinal lymph node dissection add radical vulvectomy;two groups of patients with clinical FIGO stage,age,height and weight differences were not statistically significant.Compared with VEILand OPLgroup,the results are as follows: 1 The hospital related index: total hospitalization days((19.07±5.19)days vs.(23.58±6.83)days,P=0.035),postoperative hospitalization days((13.13±2.80)days vs.(16.29±4.53)days,P=0.021),the differences were statistically significant.2 The surgery related indicators: the operation time((159.38±48.39)min vs.(153.13±28.26)min,P=0.654),left number(7.13±3.72 vs.8.50±4.04,P=0.297)or right number(8.20±4.25 vs.7.67±3.53,P=0.674)of resected lymph nodes,there were no significant differences in the total hospitalization expenses;intraoperative blood loss((57.33±37.31)ml vs.(95.42±54.37)ml,P=0.023)and postoperative drainage tube placement time((9.27±2.09)days vs.(11.88±3.84)days,P=0.009),the difference was statistically significant.3 Postoperative complications: postoperative complications(short-term complications: groin flap necrosis,wound infection,wound dehiscence,lymphatic cyst and long-term complications of lower limb lymphedema Swelling and lymph leakage)incidence rate(20% vs.29.2%,P=0.026)were statistically significant differences.4 The pathological data and recurrence after operation: the cases of positive lymph nodes(3 cases vs.5cases,P=0.950)was not statistically significant;The VEIL group,there were 1 cases with inguinal region recurrence with mirror hole(1/15,6.67%);the OPL group,there were 3 cases of recurrence,including 2 cases of local recurrence of vulva,1 cases of right inguinal recurrence(3/24,12.5%).5 The economic indicators: total hospitalization cost((20589.02±3874.83)yuan vs.(25141.19±5104.93)yuan,P=0.005),operation cost((4443.33±254.32)yuan vs.(3406.67±214.73)yuan,P<0.001),the cost of anesthesia((1292±352.28)yuan vs.(1212.63±134.42)yuan,P=0.324)and after the operation related costs((1391.87±9495.14)yuan vs.(5094.42±3074.21)yuan,P<0.001)were less than open group,with statistical significance;the cost of anesthesia((1292±352.28)yuan vs.(1212.63±134.42)yuan,P=0.324)had no significant difference.All patients were followed up for 2 months,and no death occurred about recurrence of vulvar squamous cell carcinoma in all the patients in the two groups.Conclusion:1 Laparoscopic surgery can be achieved with open surgery as tumor control effect,in the operation time,the number of lymph nodes can balance with open surgery,the intraoperative bleeding volume,postoperative drainage tube time,postoperative hospital stay and postoperative complications were superior to open surgery;2 Video endoscopic inguinal lymphadenectomy has more better economic benefit to patients with vulvar squamous cell carcinoma;3 For the surgical treatment of vulvar squamous cell carcinoma,video endoscopic inguinal lymphadenectomy is a feasible operation and worthy of promotion;4 For the long-term recurrence after surgery,long-term follow-up is still needed to carry out with a comparative study of large data. |
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