腹腔镜下膀胱全切除前后施行盆腔淋巴结清扫术疗效对比  

Comparison of the efficacy of performing pelvic lymph node dissection before versus after laparoscopic radical cystectomy

作　　者：梅延辉[1] 张冰[1] 燕东亮[1] 苏庆国[1] 曹景源[1] 

机构地区：[1]滨州医学院附属医院泌尿外科,山东滨州256603

出　　处：《现代泌尿外科杂志》2016年第10期782-785,共4页Journal of Modern Urology

基　　金：滨州市科技发展计划(No.2014ZC0157);滨州医学院科技计划(No.BY2014KJ38)

摘　　要：目的探讨腹腔镜下根治性膀胱切除(LRC)前后实施标准淋巴结清扫(PLND)对疗效的影响。方法回顾性分析2013年10月至2016年5月行腹腔镜下标准PLND+LRC且具备完整病理资料的62例膀胱癌患者。均为男性,平均年龄(60±11)岁。根据手术顺序的不同进行分组:PLND后再行LRC(前PLND组)32例;LRC后再行PLND(后PLND组)30例。比较两组患者临床及病理特征、手术时间、清除的淋巴结数目、阳性淋巴结检出率和并发症等。结果比较采用χ2检验和t检验。结果临床及病理特征两组患者无统计学差异(P>0.05)。前PLND组和后PLND组两组PLND时间分别为(65±22)与(58±23)min,差异无统计学意义(P>0.05)。两组切除膀胱的时间分别为(86±36)与(124±34)min;清除淋巴结数目分别为(16.5±7.1)与(21.2±7.6)枚,差异有统计学意义(P<0.05)。阳性淋巴结检出率分别为10.0%(53/528)与9.2(58/636);并发症总发生率分别为18.8%(6/32)与16.7%(5/30),差异无统计学意义(P>0.05)。结论膀胱癌行LRC时,首先行PLND能够方便下一步的膀胱切除操作,膀胱全切后须再次检查淋巴结清扫是否彻底,必要时补充清扫。Objective To compare the therapeutic efficacies of pelvic lymph node dissection （PLND） before versus after laparoscopic radical cystectomy （LRC） in bladder cancer patients. Methods Clinical data of 62 male badder cancer patients with median age of 60 who underwent PLND plus LRC treated during Oct. 2013 and May 2016 were collected and analyzed. The patients were divided into pre-PLND group and after-PLND group. The two groups were compared in terms of clinical and pathological characteristics, operation time, numbers of lymph nodes removed, positive rates in dissected lymph nodes and operative complications. Results were analyzed with Chi-square or Student＇s test. Results There was no significant difference between the two groups in the clinical, pathological characteristics and mean operation time of PLND （P〉 0.05）. Nevertheless, the mean operation time of LRC was significantly shorter in pre-PLND group than in after-PLND group[（86 ±36） vs. （124±34）min, P〈0.01]. In addition, the mean number of lymph nodes removed was fewer in pre-PLND group than in after- PLND group [（16.5±7.1） vs. （21.2±7.6）, P〈0. 05]. No remarkable difference was observed between the two groups in dissected lymph nodes [10.0%（53/528） vs. 9.2% （58/636）] and operative complications [18.8% （6/32） vs. 16.7% （5/30）, all P〉0.05）]. Conclusion To shorten operation time of LRC, PLND should be performed beforehand followed by complete pelvic lymph nodes dissection after LRC.

关 键 词：膀胱肿瘤 腹腔镜 全膀胱切除术 淋巴结清扫术 淋巴结阳性 

分 类 号：R694[医药卫生—泌尿科学]