Application Of Laparoscopy Combined With Open Inguinal Lymph Node Dissection In Lymph Node Metastasis Of Melanoma

Objecttive:At present,melanoma has become one of the fastest growing malignant tumors.Traditional drug therapy is ineffective.There is no effective method to treat melanoma by lymphatic metastasis to lymph nodes in abdominal cavity and ilioinguinal region.With the developmentof surgical technology,laparoscopic celiac lymphadenectomy has become a routine surgical method.It can provide the function of enlarging the image and make the surgeon have a clearer vision.After years of clinical verification,laparoscopy has been widely recognized for its advantages of rapid recovery and minimal trauma.However,the traditional open surgery for inguinal lymph node dissection still has considerable clinical advantages.Open surgery for the scope and thoroughness of lymph node dissection is better than laparoscopic lymph node dissection.A question arises as to whether laparoscopic and open surgery can be combined to treat melanoma lymph node metastasis.The purpose of this study was to investigate the effect of laparoscopic combined with open ilioinguinal lymph node dissection in the metastasis of melanoma.Methods:This study included 9 patients with metastatic melanoma admitted to Department of Urology,Xijing Hospital from May 2015 to February 2017.All patients were examined by radiographic examination of the iliac vessels and / or inguinal lymph nodes after resection of the lower extremities,and 9 patients were enrolled in the study.All patients had indications of surgical treatment and no contraindications.Laparoscopic retrograde dissection of parailiac lymph nodes from iliac bifurcation and open dissection of inguinal lymph nodes were selected.The operative time,blood loss,postoperative time of getting out of bed,postoperative hospital stay and postoperative complications were recorded.Results:All 9 operations were successfully completed.Theoperative time was(150.9 +41.08)min,the intraoperatve blood soss was(55 +21.51)ml,postoperative time to get out of bed was(3.111 +1.167)d,and the hospitalization time was(8.566 +2.186)d after the operation.The ratio of the number of positive pelvic lymph nodes to the number of acquired lymph nodes was 1 in 4,2 in 2,1 in 1,2 in 16,5 in 5,8 in 8,3 in 16,1 in 11,4 in 13,and the ratio of positive inguinal lymph nodes to acquired lymph nodes was 3in 4,0 in 8,1 in 1,1 in 10,1 in 1,3 in 7,0 in 0,0 in 3,4 in 13,respectively.All the patients were confirmed by pathology as paravascular lymph node and / or inguinal lymph node metastasis.All patients were followed up for 2-4 years without recurrence or metastasis.Conclusion:Laparoscopic combined with open ilioinguinal lymphadenectomy is a new surgical approach for the treatment of melanoma metastasis.Compared with the original surgical approach,this surgical approach has less trauma,faster recovery and thorough clearance,and has certain clinical value.However,the number of cases is small,and further accumulation and improvement are needed to verify its clinical effects.