膀胱癌盆腔淋巴结转移的规律及影响因素分析  

Pattern and risk factors of lymph node metastasis in patients undergoing laparoscopic radical cystectomy and lymph node dissection for bladder cancer

作　　者：谢伟槟[1] 刘皓[1] 孔坚秋 苏扬帆 毕峻铭 董文[1] 林天歆[1] 黄健[1] Xie Weibin;Liu Hao;Kong Jianqiu;Su Yangfan;Bi Junming;Dong Wen;Lin Tianxin;Huang Jian(Department of Urology,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510120,China)

机构地区：[1]中山大学孙逸仙纪念医院泌尿外科,广州510120

出　　处：《中华腔镜泌尿外科杂志（电子版）》2018年第6期397-401,共5页Chinese Journal of Endourology(Electronic Edition)

基　　金：广东省医学科学技术研究基金(A2018388);广东省科技发展专项资金(2017B020227007);广东省自然科学基金(2016A030313244);广州市科技计划项目(201604020177);逸仙临床研究培育项目(SYS-Q-201703)

摘　　要：目的通过分析膀胱尿路上皮癌淋巴结转移的规律及其相关影响因素,结合盆腔淋巴清扫的研究进展,探讨盆腔淋巴清扫策略。方法收集我院2008年至2016年由同一术者完成腹腔镜根治性膀胱切除和盆腔淋巴清扫的膀胱尿路上皮癌患者的资料,回顾性分析淋巴结转移的规律及其相关影响因素。结果共收集患者285例,69例(24.2%)发生淋巴结转移。最常见的淋巴结转移部位为髂内/闭孔淋巴结(57/69,82.6%),其次是髂外淋巴结(37/69,53.6%);真骨盆外淋巴结转移均伴随髂内/闭孔或髂外淋巴结转移;单侧壁膀胱癌可以向对侧盆腔淋巴结转移。T1组淋巴结转移率4.6%(4/87),T2组18.0%(18/100);T3组50.8%(30/59);T4组68.0%(17/25)。多因素回归分析显示淋巴结转移与肿瘤分期呈正相关,与分级、年龄、性别、体质量指数、吸烟等因素无关。结论髂内/闭孔和髂外淋巴结是膀胱癌最主要的淋巴结转移部位,肿瘤高分期是影响膀胱癌淋巴结转移的主要因素。根治性膀胱切除术应行至少包括双侧髂内、闭孔、髂外淋巴结的标准淋巴清扫。Objective To investigate the pattern and risk factors of pelvic lymph node metastasis in patients with bladder cancer treated with laparoscopic radical cystectomy and pelvic lymphadenectomy. Methods Data of 285 patients underwent laparoscopic radical cystectomy and pelvic lymphadenectomy in our hospital from 2008 to 2016 by the same surgeon was retrospectively collected. The characteristics and risk factors of lymph node metastasis were analyzed. Results 285 patients （24.2%） had lymph node metastasis. The most common site of lymph node metastasis was the internal iliac/obturator lymph node （57/69, 82.6%）, followed by the external iliac lymph node （37/69, 53.6%）. External pelvic lymph node metastasis was accompanied by true pelvic lymph node metastasis. Tumor location and lymph node metastasis were significantly correlated. However, lymphatic drainage from the bladder seemed to be bilateral. The incidence in different stages 4.6% （4/87） in T1, 18.0% （18/100） in T2, 50.8% （30/59） in T3, 68.0% （17/25） in T4. The incidence of lymph node metastasis was positively correlated with tumor stage. Conclusion The most common lymph node metastases in bladder cancer are the internal iliac/obturator and external iliac lymph nodes. Radical cystectomy should be performed with lymphadenectomy including at least bilateral internal iliac, obturator and external iliac lymph nodes.

关 键 词：膀胱癌 腹腔镜 膀胱切除术 淋巴清扫 

分 类 号：R737.14[医药卫生—肿瘤]