盆腔淋巴结清扫在根治性前列腺切除术中的意义  

Significance of pelvic lymph node dissection in radical prostatectomy

作　　者：何威[1] 谢欣[1] 徐兆平[1] 张荣明[1] 沈周俊[2] 祝宇[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院,上海200025 [2]复旦大学附属华山医院泌尿外科

出　　处：《临床泌尿外科杂志》2017年第7期529-532,共4页Journal of Clinical Urology

基　　金：上海市卫计委面上项目支持(编号201540081)

摘　　要：目的:探讨盆腔淋巴结清扫在根治性前列腺切除术中的意义。方法:对266例接受前列腺癌根治性切除及盆腔淋巴结清扫的患者的临床资料进行回顾性分析。患者术前均诊断为局限性前列腺癌,平均年龄(66.5±5.5)(58~82)岁。高危者68例,中危者155例,低危者43例。130例行耻骨后根治性前列腺切除术(retropubic radical prostatectomy,RRP),33例行腹腔镜根治性前列腺切除术(laparoscopic radical prostatectomy,LRP),103例行达芬奇机器人辅助腹腔镜根治性前列腺切除术(robot assisted laparoscopic radical prostatectomy,RALRP)。其中标准盆腔淋巴结清扫(standard pelvic lymph node dissection,sPLND)者181例,扩大盆腔淋巴结清扫(extended pelvic lymph node dissection,ePLND)者85例。标准盆腔淋巴结清扫范围包括双侧闭孔及髂外淋巴结,扩大盆腔淋巴结清扫在标准盆腔淋巴结清扫的基础上尚切除髂内淋巴结及髂总淋巴结。淋巴结阳性患者术后均予辅助性内分泌治疗。结果:手术时间(operating time,OT)sPLND组(12.6±0.2)min,ePLND组(30.6±2.1)min(P=0.0012);平均失血量(estimated blood loss,EBL)sPLND组(25.7±5.5)ml,ePLND组(60.2±8.3)ml(P=0.0021);清扫淋巴结数目sPLND组(9.0±2.3)枚,阳性病例率8.3%,ePLND组(26.2±5.8)枚,阳性病例率17.6%(P=0.024)。术后平均住院天数(hospital stay,HS)sPLND组(7.8±0.2)d,ePLND组(9.8±0.4)d(P=0.11)。sPLND组11例(6.1%)出现淋巴清扫术后相关并发症,ePLND组11例(12.9%)出现淋巴清扫术后相关并发症(P=0.058)。在sPLND组和ePLND组分别计算低危组、中危组和高危组的手术时间、失血量、住院天数和并发症比率,其差异无统计学意义。在85例ePLND中,手术时间在RRP组、LRP组、RALRP组分别为(28.8±0.4)min、(47.8±0.9)min和(26.5±0.3)min(P=0.06);失血量在RRP组、LRP组、RALRP组分别为(30.3±2.5)ml、(62.7±5.2)ml和(38.1±3.7)ml(P=0.11);术后住院天数在RRP组、LRP组、RALRP组分别为(10.2±0.8)d、(8.8±0.5)d和(7.5±0.Objective：To discuss the significance of pelvic lymph node dissection（PLND）in radical prostatectomy.Method：The perioperative data of 266 cases undergoing radical prostatectomy and simultaneous PLND were analyzed retrospectively.All the cases were diagnosed as localized prostate cancer including 68 high risk cases,155 median risk cases and 43 low risk cases.Their mean age was（66.5±5.5）（58-82）years old.Of which,there were130 cases undergoing retropubic radical prostatectomy（RRP）,33 cases undergoing laparoscopic radical prostatectomy（LRP）and 103 cases undergoing robot-assisted laparoscopic radical prostatectomy（RALRP）.Standard pelvic lymph node dissection（sPLND）were performed in 181 cases,and extended pelvic lymph node dissection（ePLND）were performed in the remaining cases.Bilateral external iliac and obturator lymph nodes were resected in sPLND,whereas besides the above resection range internal and common iliac lymph nodes were all resected in ePLND.Adjuvant hormonal therapy was administered in positive lymph node patients.Result：The mean operating time（OT）was（12.6±0.2）min in sPLND group,and（30.6±2.1）min in ePLND group（P=0.0012）.The mean estimated blood loss（EBL）was（25.7±5.5）ml in sPLND group,and（60.2±8.3）ml in ePLND group（P=0.0021）.The mean harvested lymph nodes number was（9.0±2.3）in sPLND group with a 8.3% positive rate,and（26.2±5.8）in ePLND group with a 17.6% positive rate（P=0.024）.The mean postoperative hospital stay（HS）was（7.8±0.2）days in sPLND group,and（9.8±0.4）days in ePLND group（P=0.11）.There were 11cases（6.1%）who suffered from complications in sPLND group,and 11cases（12.9%）in ePLND group（P=0.058）.In sPLND group or ePLND group,the difference of OT,EBL,HS and complication rates did not show the statistical significance among low risk,median risk and high risk groups,respectively.In ePLND,the mean OT was（28.8±0.4）min in RRP group,（47.8±0.9）min in LRP group and（26.5±0.3）min in R

关 键 词：前列腺癌 根治性前列腺切除术 盆腔淋巴结清扫 

分 类 号：R737.25[医药卫生—肿瘤]