标准盆腔淋巴结清扫术在膀胱癌根治术中的应用研究

目的探讨标准盆腔淋巴结清扫术在膀胱癌根治术中的应用价值。方法回顾研究2008-2012年间徐州医学院附属医院行全膀胱根治性切除术加标准盆腔淋巴结清扫的79例膀胱癌患者的临床资料，其中男69例，女10例。初发53例，复发26例；临床分期：TO～T16例，T241例，1322例，T410例；病理分级：G110例，G240例，G329例；病理分类：尿路上皮癌69例，腺癌4例，鳞状细胞癌4例，膀胱小细胞癌2例。79例均行膀胱癌根治术及标准的双侧区域盆腔淋巴结清扫术。结果79例清扫手术平均时间47min。平均出血量20ml，术中未发生重要血管及神经损伤。清扫淋巴结数目4—31枚，平均16枚，淋巴结阳性率为15．2％（12／79）。术后随访5～52个月，中位时间32个月，死亡13例（16．45％，13／79），总体生存率为83．5％（66／79）。从临床分期分析，仍、T4期3年生存率分别为66％、40％（P〈0．05）。从不同组织学分级分析，G2、G3级3年生存率分别为90％、57％（P〈0．05），其中淋巴结阳性患者3年生存率为50．6％，阴性患者为87．2％（P〈0．05）。结论膀胱癌根治术中行标准的双侧盆腔淋巴结清扫能提高分期准确性和患者生存率，无严重并发症，是一种安全、有效的手术方式。

Application of standard pelvic lymphadenectomy in radical cystectomy

Objective To discuss the application of standard pelvic lymphadenectomy in radical cystectomy. Methods 79 patients with bladder cancer （69 males and 10 females） undergoing radical cystectomy in the Affiliated Hospital of Xuzhou Medical College from 2008 to 2012 were enrolled in the study. Clinical data were reviewed. Among all patients, 53 were newly diagnosed and 26 had recurrent disease. Clinical staging showed that 6 cases were classified as TO - T1, 41 as T2, 22 as T3, and 10 as T4. Pathological staging showed that 10 were classified as grade 1,40 as grade 2, and 29 as grade 3. 69 cases were pathologically classified as urothelial cell carcinoma, 4 as adenocarcinoma, 4 as squamous cell carcinoma, and 2 as small cell carcinoma. Bilateral pelvic lymphadenectomy was performed in all patients according to standard protocol. Results The procedure of bilateral lymphadenectomy lasted for an average of 47 min and the average blood loss was 20 ml during the procedure. No important vessel and nerve injuries occurred during the procedure. An average of 16 lymph nodes （range, 4 -31 ） were removed. The rate of positive lymph nodes was 15.2% （12/ 79）. Median follow - up time was 31 months （ range, 5 - 52）. 13 cases （ 16.45% ） died during follow - up and the over -all survival rate was 83.5% （66/79）. Based on the analysis of clinical staging, there were no death in T1 and T2 stages during the follow - up. The 3 - year survival rates of T3 and T4 stages were 66% and 40% respectively （ P 〈 O. 05 ）. Based on the analysis of pathological grading, the 3 -year survival rates of G2 and G3 were 90% and 57% （P 〈0.05） respectively. The 3 - year survival rate was 50.6% in patients with positive lymph nodes and was 87.2% in patients with negative lymph nodes （ P 〈 0.05 ）. Conclusion Bilateral pelvic lymphadenectomy should be routinely performed during radical cystectomy. Standard bilateral pelvic lymphadenectomy could document the staging accurately and improve the overall survival in radical eystectomy without severe complications.