探讨在阴茎癌患者中用吲哚菁绿（ICG）荧光成像引导下进行机器人辅助改良顺行腹股沟淋巴结清扫的方法及疗效。

回顾性分析2022年6月至2024年7月广东省人民医院收治的4例阴茎癌患者的临床资料。4例患者中位年龄61.5岁，范围52~72岁。4例临床分期均为T₁期（侵犯皮下结缔组织）。术前查体及辅助检查均提示腹股沟淋巴结肿大，其中1例提示左侧盆腔淋巴结肿大，N₁期2例，N₂期1例，N₃期1例，均无远处转移。手术方法：患者取平卧位，术前于阴茎根部注射ICG，在ICG引导下行精准腹股沟及盆腔淋巴结清扫术。

4例患者手术均顺利完成，无中转开放手术，术中均无需移动机械臂系统。其中1例术中利用原套管位置进入腹腔，同期行盆腔淋巴结清扫术。4例患者共8侧手术和1侧盆腔淋巴结清扫术，每侧中位手术时间为60 min，范围50~70 min；术中出血量每侧均<10 mL。左侧腹股沟清扫淋巴结数量中位数为4枚，范围为3~14枚；右侧腹股沟清扫淋巴结数量中位数为4枚，范围为2~9枚。患者均术后10 d内伤口拆线，未发生皮肤坏死、伤口延迟愈合、蜂窝织炎等并发症。患者引流管拔除时间为5~40 d，中位时间11 d，其中1例腹股沟区出现淋巴漏，延期拔管。术后随访时间5~25个月，所有患者的原发灶、腹股沟及盆腔淋巴结均无肿瘤复发、转移。

在ICG荧光引导下机器人辅助改良顺行腹股沟淋巴结清扫术可以精确区分淋巴结的位置并与周围组织准确分离，显著提高腹股沟淋巴结清扫术的疗效并减少术后并发症的发生。

To investigate the method and efficacy of robot-assisted modified antegrade inguinal lymphadenectomy guided by indocyanine green (ICG) fluorescence imaging in patients with penile cancer.

The clinical data of 4 patients with penile cancer from June 2022 to July 2024 were retrospectively analyzed. The median age of the 4 patients was 61.5 years, ranging from 52 to 72 years. Clinical stage: 4 cases were T₁ (subcutaneous connective tissue invasion), preoperative physical examination and auxiliary examination showed inguinal lymph node enlargement, of which 1 case showed left pelvic lymph node enlargement, including 2 cases of N₁ stage, 1 case of N₂ stage and 1 case of N₃ stage. No distant metastasis was observed. Surgical methods: the patient was placed in the supine position, and ICG was injected into the root of the penis before operation. Precise inguinal lymphadenectomy and pelvic lymphadenectomy were performed under the guidance of ICG.

All operations were successfully completed without conversion to open surgery and without the need for mobile robotic arm system. In one case, the original cannula position was used to enter the abdominal cavity, and pelvic lymphadenectomy was performed at the same time. A total of 8 operations and 1 pelvic lymphadenectomy were performed in 4 patients. The median operation time of each side was 60 min, ranging from 50 to 70 min. The intraoperative blood loss was less than 10 ml on each side. The median number of left lymph nodes dissected was 4, ranging from 3 to 14. The median number of right lymph nodes dissected was 4, ranging from 2 to 9. Stitchings were removed in all the 4 cases within 10 days after operation, and no complications such as skin necrosis, delayed wound healing, and cellulitis occurred. The drainage tube removal time of 4 cases ranged from 5 to 40 days, with a median time of 11 days. One of them had lymphatic leakage in the inguinal region and delayed removal of the tube. All patients were followed up for 5-25 months, and no tumor recurrence or metastasis was found in the primary tumor, inguinal and pelvic lymph nodes.

Robot-assisted modified anterograde inguinal lymphadenectomy under the guidance of ICG fluorescence can accurately distinguish the location of lymph nodes and separate them from the surrounding tissues, significantly improve the efficacy of inguinal lymph node dissection and reduce the incidence of postoperative complications.