腹腔镜扩大盆腔淋巴结清扫在高危前列腺癌治疗中的应用

分析12例高危前列腺癌患者的临床资料. 所有患者行腹腔镜扩大盆腔淋巴结清扫联合根治性前列腺切除术,探讨淋巴结清扫手术方式的改进和骶前、髂总、髂外、髂内、闭孔5个部位淋巴结的转移情况. 12例手术均顺利完成,无中转开放手术,共切除淋巴结301枚,平均25枚,96枚发生转移,转移率为32%. 对于高危前列腺癌患者施行根治性前列腺切除时行扩大盆腔淋巴结清扫,按照改进后的顺序进行,可以避免遗漏和反复操作,同时能够发现更多标准盆腔淋巴结清扫术范围以外的转移性淋巴结. 其意义不仅在于能够获得更为准确的肿瘤TNM分期,更重要的是切除了尚未发现的微小转移灶,有益于改善疾病进展和患者的长期生存.

The application of expand pelvic lymphnode dissection by laparoscopic in high-risk prostate cancer

To analyze the data of 12 patients with high-risk prostate cancer, who accepted laparoscopic expand pel-vic lymphnode dissection and radical prostatectomy, retrospectively. To evaluate the improvement of lymph node dissection operation skills and the transfer situation about anterior sacral lymph nodes, common iliac lymph nodes, external iliac lymph nodes, internal iliac lymph nodes, obturator lymph nodes. All the operations were completed by laparoscopy and no patient was converted to open surgery. Totally, 301 lymph nodes were dissected. The num-ber of dissected lymph nodes in each patient ranged from 20 to 36 ( mean 25 ) . Among them,91 lymph nodes were found with the evidence of metastasis(32%) . As a part of treatment for high risk prostate cancer, more metastatic lymph nodes could be found than a standard pelvic lymph node dissection by using the laparoscopic extended pelvic lymph node dissection during radical prostatectomy. Not only for more accurate TNM staging, more importantly, it removes micrometastases which will benefit the patients with disease progression, and improves long-term survival.