外阴癌根治术后难治性双侧腹股沟淋巴漏的多学科协作诊治一例

Refractory Bilateral Inguinal Lymphorrhea After Radical Vulvectomy:A Multidisciplinary Case Report

  • 摘要: 外阴鳞状细胞癌(vulvar squamous cell carcinoma, VSCC)在妇科恶性肿瘤中相对少见,手术是早期患者的首选治疗方案,但术后淋巴漏、感染等并发症并不少见,腹股沟淋巴结清扫术后淋巴漏发生率为10%~30%。本文报道1例70岁外阴高分化鳞状细胞癌(ⅠB期)患者,于2025年5月22日行广泛外阴切除术联合双侧腹股沟淋巴结清扫术;术后出现双侧腹股沟淋巴漏伴感染;保守治疗效果不佳,于2025年6月13日行二次清创术联合淋巴管结扎术;二次术后引流液逐渐减少并顺利拔管,切口愈合良好,术后随访1个月病情恢复良好。本案例的诊疗过程提示,外阴鳞状细胞癌相对少见,而术后出现淋巴漏合并感染的情况更为少见且复杂,针对外阴癌术后并发症的处理策略为实施“先保守后手术”的阶梯治疗模式,并依托多学科诊疗机制实现精准诊治。

     

    Abstract: Vulvar squamous cell carcinoma (VSCC) is relatively rare among gynecologic malignancies. Surgery is the preferred treatment option for early-stage patients, but postoperative complications such as lymphatic leakage and infections are not uncommon, with an incidence of lymphatic leakage after inguinal lymphadenectomy approximately 10%-30%. This article reports a case of a 70-year-old patient with well-differ- entiated squamous cell carcinoma of the vulva (stage Ⅰ B), who underwent extensive vulvectomy + bilateral in- guinal lymphadenectomy on May 22, 2025, and developed bilateral inguinal lymphatic leakage accompanied by infection postoperatively. Initially, conservative treatment was adopted, but the effect was poor, leading to a second debridement + lymphatic leakage ligation on June 13. After the second surgery, the drainage fluid gradu- ally decreased, and the drainage tube was successfully removed, with good incision healing. Follow-up after one month showed good recovery of the condition. The uniqueness of this case lies in the relative rarity of vulvar squamous cell carcinoma itself, as well as the uncommon and complex occurrence of postoperative lymphatic leakage combined with infection, and its management strategy provides important references for clinical practice. Through the analysis of this case, the aim is to explore the management methods for complications after vulvar cancer surgery, in order to provide insights for the clinical management of similar patients.

     

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