Discrete radical total vulvectomy

Separate radical total vulvectomy is used for surgical treatment of vulvar and vestibular large adenocarcinoma. The vulvar organs, in addition to fat, sweat glands, sebaceous glands, and nerve vessels, are also rich in lymphoid tissues, and the haze is the main trunk of the labia majora on both sides, which is the intersection of upward reflow. Therefore, from the anatomy and clinical findings, the vulva Cancer should be treated with extensive vulvar resection. Extensive removal of the upper part of the vulva includes resection of the vulva, the outer side is the labia majora fold, and the lower edge includes the perineum. The external incision should be 3 cm from the tumor. The vaginal wall, the base of the vulva, and the upper edge of the vaginal fascia within 10 cm of the medial resection are the pubic fascia, and both sides include the excision adductor fascia. The removal of pelvic lymph nodes cannot be generalized. It should be different according to the specific case. The following indications should be strictly controlled: 1 For those with inguinal lymph node metastasis, the pelvic lymph nodes must be removed. 2 From the clinical point of view, where more than 1/3 of the vestibule, clitoris, urethra or vagina are affected by cancerous foci, it is necessary to remove the pelvic lymph nodes. The pathological examination of 3Cloquet's lymph nodes has clinical significance and can determine pelvic lymph node clearance. Treatment of diseases: vulvar cancer Indication 1. The cancer is confined to the genital area, the diameter is 2cm, the base can move, and the lower fascia is not tired. 2. The cancer is limited to the vulva, the inguinal lymph nodes are swollen, hard and active, and the suspicious cancer metastasis. 3. This procedure is more suitable for the lesions on the lateral side of the vulva and the posterior part of the perineal body. The small anterior vulva and no inguinal lymph node metastasis can retain all or more of the pubic skin bridge at the same time. Heal. Contraindications 1. Where the bottom of the cancer is fixed, involving the pelvic floor fascia or pubic periosteum, or the inguinal lymph nodes are enlarged and fixed or ulcerated, it is not suitable for surgery. 2. Patients with advanced cancer liver and lung metastasis can receive systemic chemotherapy or palliative care. 3. Patients with severe heart, lung and liver complications. Preoperative preparation 1. Regular checkup, laboratory tests and exclusion of contraindications. 2. X-ray pelvic radiographs, except for bone metastases. And do the special examination of the cervix, anorectal, bladder to rule out cancer metastasis. 3. The original lesion is broken, preoperative 1:5000 potassium permanganate solution or 1:1000 Xinjieer to sit off the bath. 4. The vulva is prepared for skin, fasting before surgery, cleansing the enema, and emptying the bladder. 5. Preoperative antibiotics prevent infection. Surgical procedure Separate inguinal lymphadenectomy Principles of resection: 1 routine includes the inguinal ligament surface lymph nodes, the proximal end of the triangle and the fascia fascia deep lymph nodes. All deep deep lymph nodes were removed, but the fascia was not removed. 2 It is not necessary to remove the skin in the groin area unless there is a large inguinal lymph node metastasis or lymph node metastasis infiltrating the skin. 3 The inguinal incision is separated from the vulva incision. 4 If necessary, the inguinal region should be repaired with a muscular flap to protect the blood vessels in the inguinal region. 5 surgical flaps must be drained and pressure bandaged to prevent lymphatic cysts. 2. Complete the vulvar incision Including the inner ring and the outer ring incision, the internal and external cutting edges should be 2 to 3 cm away from the cancerous lesion. The lower part of the incision has a wedge shape on both sides to form a perineum, and the depth of the outer ring incision should reach the urogenital submental fascia. The outer ring incision is combined with the upper part of the upper part of the labia and the lateral side of the labia majora. The lateral edge of the incision reaches the fold of the labia and the foot. It is necessary to pay attention to leaving some of the lateral labia majora, which will help the incision suture. The inner ring incision is cut from the vaginal mucosa above the urethral opening, and the subcutaneous space of the clitoris is separated. 3. Vulvar anterior resection Excision of the outer flap of the outer ring incision and the fat pad of the labia until the fold of the labial foot, then expanding in both directions forward and backward, excising the separated anterior vulvar tissue from the pubic symphysis, pubic symphysis, lower edge of the pubic bone and clitoris Root removal. Following the separation and removal of the labia majora fat pad and the corpus cavernosum muscle, and clamped down the gap along the clitoris foreskin, the vaginal tissue was separated from the pubic symphysis. The inner ring incision is enlarged to the outside to reach the base of the labia minora. Then, the incision is extended posteriorly along the outer edge of the hymen ring until the lower edge of the incision of the inner ring, and the anterior vulva tissue is released. 4. Cut along the inner and outer ring incision of the anterior vulva to the posterior and inferior, and connect the perineal body to the contralateral inner and outer ring incisions. From the lateral edge to the deep part to the deep fascia, it can be seen that the fascia sac is attached to the subpubic or perineal fascia capsule. The resection of the perineal surface is located at the fascia level surrounding the anal sphincter. If the lesion involves the perineal mucosa or scaphoid, the anterior sphincter should be scraped off without causing fecal incontinence. In order to avoid damage to the rectum, surgery can be performed under the guidance of anal examination. 5. Vulva formation After extensive resection, in order to prevent pelvic floor defects, the levator ani muscle, the anterior and posterior vaginal wall and the perineal body should be properly repaired. Due to difficulty in suturing around the urethra, it can be left exposed until the granulation tissue is repaired. Deep wounds and severe tissue defects can be formed by bilateral rhomboid, rectangular and other flaps. Postoperative diet 1. Give high protein, high vitamin and cellulose-rich digestible diet. 2, do not eat spicy spicy food.