Radikal Vulvektomi ve Bilateral İnguinal Lenf Nodu Diseksiyonu
Özet
Radikal vulvektomi ve bilateral inguinal lenf nodu diseksiyonu, vulva karsinomu tedavisinde tarihsel olarak geniş doku eksizyonu ve yüksek morbidite oranlarıyla uygulanan geleneksel yöntemlerdir. Ancak günümüzde cerrahi yaklaşımlar, hastanın anatomik yapısına ve tümörün özelliklerine göre bireyselleştirilerek daha konservatif hale getirilmiştir. Modern prosedürlerin temel amacı, hastanın psikoseksüel, mesane ve anal sfinkter fonksiyonlarını korurken, tümör çevresinde en az 2 cm'lik optimum cerrahi sınırı sağlayarak tam rezeksiyonu gerçekleştirmektir. Cerrahi operasyon kapsamında total veya kısmi vulvektomiye ek olarak distal üretratomi, vajinektomi, anovulvektomi ve sigmoid kolostomi gibi yardımcı prosedürler uygulanabilmektedir. İnguinofemoral lenf nodlarının tutulumu en önemli prognostik gösterge olup, tam lenfadenektominin neden olduğu yüksek morbiditeyi ve lenfödem riskini azaltmak amacıyla sentinel lenf nodu (SLN) biyopsisi standart bir yöntem haline gelmiştir. Operasyon sonrası süreçte yara yeri ayrılması, enfeksiyon ve lenfödem en sık karşılaşılan erken ve geç dönem komplikasyonlar arasında yer almaktadır. Büyük doku defektlerini kapatmak için rhomboid, lotus petal veya miyokütanöz transpozisyon flepleri kullanılarak rekonstrüksiyon sağlanır.
Radical vulvectomy and bilateral inguinal lymph node dissection are traditional methods historically performed in the treatment of vulvar carcinoma with extensive tissue excision and high morbidity rates. However, contemporary surgical approaches have become more conservative, being individualized based on the patient's anatomical structure and tumor characteristics. The primary objective of modern procedures is to achieve complete resection by ensuring an optimum surgical margin of at least 2 cm around the tumor while preserving the patient's psychosexual, bladder, and anal sphincter functions. In addition to total or partial vulvectomy, adjunctive procedures such as distal urethrectomy, vaginectomy, anovulvectomy, and sigmoid colostomy can be performed within the scope of the surgical operation. Inguinfemoral lymph node involvement is the most significant prognostic indicator, and sentinel lymph node (SLN) biopsy has become a standard method to reduce the high morbidity and lymphedema risk caused by complete lymphadenectomy. Wound dehiscence, infection, and lymphedema are among the most frequently encountered early and late complications in the postoperative period. To close large tissue defects, reconstruction is achieved using transposition flaps such as rhomboid, lotus petal, or myocutaneous flaps.
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