前列腺癌盆腔各解剖区域淋巴结转移特点及其临床意义

目的：探讨前列腺癌盆腔各解剖区域淋巴结转移特点及其临床意义。方法：收集因前列腺癌而行前列腺根治切除＋分区盆腔淋巴结清扫术93例患者的临床病理资料，将盆腔淋巴结分为9区5组，明确盆腔各解剖区域淋巴结转移的频率和分布，比较各组淋巴结转移率和转移度。结果：全组有25例发生淋巴结转移，转移率为26．9％（25／93）。低、中、高危组前列腺癌的淋巴结转移率分别为2．6％（1／39）、30．0％（9／30）、62．5％（15／24）。各组转移率由高到低排列为髂内、闭孔、髂外、骶前和髂总，分别为16．4％（11／67），15．1％（14／93），11．8％（11／93），2．3％（1／44）和0（0／67），差异有统计学意义（P〈0．01）。转移淋巴结（阳性）53枚，转移度为3．2％（53／1643）。各组转移度由高到低排列为闭孔、髂内、髂外、骶前和髂总分别为4．9％（23／468），4．0％（16／401），3．2％（12／378），0．9％（2／222）和0（0／174），差异有统计学意义（P〈0．01）。结论：①对低危组的患者可不实施盆腔淋巴结清扫；对中一高危组患者，必须实施淋巴结清扫。②清扫范围：髂外、髂内和闭孔组为必须清扫的最小区域范围；髂总和骶前组不必进行常规清扫；③可根据术中闭孔、骶前组淋巴结快速冰冻病理检查，明确有无转移，来决定盆腔淋巴结清扫最适个体化清扫范围。

Features of metastasis in different pelvic lymph node groups and their significance in radical prostatectomy for prostate cancer

Objective： To evaluate the features of metastasis in different pelvic lymph node groups and their significance in lymph node dissection in prostate cancer patients treated with radical prostatectomy. Method： The data of 93 prostate cancer patients with radical prostatectomy and pelvic lymph node dissection from January 1997 to October 2012 were analyzed retrospectively. The pelvic lymph nodes were divided into 9 regions 5 groups ac cording to the common guideline. The metastatic rate and degree of dissected lymph nodes in these patients were compared. Result： Complete pathological information was available for 93 patients, of 25 patients had lymph node metastases, including 2.6% with low, 30.0% with intermediate and 62.5% with high risk cancer. The metastatic total rate and degree of dissected lymph nodes were 26.9%%0（25/93） and 3.2%（53/1 643） respectively. The metastatic rates of lymph node groups in these patients from high to low were as follows： internal lilac（16.4 % ）, obtu rator（ 15.1% ）, external iliac （ 11. 8 % ）, presacral （ 2. 3 % ） and common iliac （ 0 ）, with a statistically significant difference in those groups（P〈0.01） . The metastatic degrees of the lymph node groups from high to low were as follows： obturator（4.9%）, internal iliac（4.0%） ,external iliac（3.2%）, presacral（0.9%） and common lilac（0）, with a statistically significant difference in those groups（P〈0.01）. Conclusion： It is not recommended to perform PLND for the low risk group. It is suggested that the regional lymph nodes with intermediate-risk and high risk group should be resected necessarily. It is also suggested that the minimum benchmark for radical cystectomy should include extensive pelvic lymph node dissection with anatomical boundaries including obturator, internal iliac and external iliac nodes. The operation optimal extent may be indicated according to the result of sentinel lymph node biopsy in the obturator or presacral group is negative or positive.