膀胱癌根治术中的盆腔淋巴结清扫

目的 总结膀胱癌根治术盆腔淋巴结清扫的疗效. 方法 膀胱癌患者95例.男76例,女19例.年龄25～78岁.初发49例、复发46例.病理分类:尿路上皮癌87例、腺癌5例、鳞状细胞癌3例.病理分级:G117例、G2 39例、G3 31例.病理分期:Ta～T1 10例、T2 54例,T3 26例、T45例.95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,清扫范围包括双侧髂内、髂外以及闭孔淋巴结. 结果 95例清扫手术平均时间20 min,平均出血量25 ml,术中未发生重要血管及神经损伤.清扫淋巴结数目1～20枚,平均10枚,淋巴结阳性率为17.9%(17/95).术后发生近期并发症12例(12.6%),包括盆腔淋巴瘘、盆腔感染、阴囊或下肢水肿.术后随访3～64个月,中位时间34个月,死亡16例,3年存活率84.5%. 结论 膀胱癌根治术中行标准的双侧区域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、有效的操作.

Pelvic lymphadenectomy in radical cystectomy

Objective To discuss the function of pelvic lymphadenectomy in radical cystectomy. Methods Ninety-five patients with bladder cancer (76 males and 19 females) underwent radical cys-tectomy. Clinical data were reviewed. Median age was 62 years old (25-78). Among all patients, 49 were newly diagnosed and 46 had recurrent disease. Of 95 patients, 87 were urothelial cell carcinoma, 5 were adenocarcinoma, and 3 were squamous cell carcinoma. Of 87 urothelial cell carcinoma cases, 17 were grade 1, 39 were grade 2, and 31 were grade 3. Of 95 patients, 10 were Ta-T1,54 were T2 ,26 were T3 ,and 5 were T4 according to AJCC classification. All cases accepted bilateral pelvic lymphade-nectomy according to standard protocol. Results Bilateral lymphadenectomy was taken an average time about 20 min. No important vessels and nerves injury occurred and average bleeding volume was 25 ml during procedure. A median of 10 lymph nodes were removed (range, 1-20). The nodal posi-tive rate was 17.9% (17/95) with 58.8% (10/17) bilateral lymph nodes positive. Short-term opera-tion-related complication rate was 12.6% (12/95). No operation-related death happened. Median fol-low up time was 34 months (3 to 64 months). Sixteen cases died during followup and the 3-year over-all survival rate was 84.5%. Conclusions Bilateral pelvic lymphadenectomy should be routinely per-formed during radical cystectomy. Standard lymphadenectomy could document accurately the staging and improve the overall survival in radical cystectomy without severe complications.