膀胱癌淋巴结转移规律的探讨

目的探讨膀胱癌淋巴结转移规律及其临床意义。方法收集因膀胱癌而行全膀胱切除术的129例患者的临床病理资料,按解剖部位将盆腔淋巴结分为10区6组,比较各组淋巴结转移率和阳性淋巴结检出率。结果全组淋巴结总转移率和阳性淋巴结检出率分别为29.5%(38/129)和6.8%(214/3142)。各组转移率由高到低排列为闭孔、髂内、髂外、髂总、骶前和肠系膜下动脉分叉以下腹主动脉及腔静脉周围,分别为20.9%、18.6%、17.1%、11.5%、9.8%和5.4%,差异有统计学意义(P<0.01)。各组阳性淋巴结检出率由高到低排列为髂总、闭孔、髂外、髂内、骶前和肠系膜下动脉分叉以下腹主动脉及腔静脉周围,分别为10.6%、10.0%、8.9%、5.3%、4.0%和1.6%,差异有统计学意义(P<0.01)。结论膀胱癌行根治性手术时,淋巴结清扫基本范围包括髂总动脉加标准盆腔淋巴结清扫。骶前和腹主动脉远端组若未发现可疑转移淋巴结者,该区域不必进行常规清扫。可根据手术所见,直接选取闭孔、骶前组淋巴结中的疑似转移者,行快速冷冻病理检查,明确有无肿瘤转移,决定是否缩小或超扩大盆腔淋巴结清扫术。

Metastasis status of lymph node in patients of bladder cancer

Objective To investigate lymph node metastasis status and their clinical signifi- cance in lymph node dissection in bladder cancer patients treated by radical cystectomy. Methods The data of 129 bladder cancer patients with radical cystectomy and pelvic lymph node dissection from January 1990 to January 2012 were analyzed retrospectively. The pelvic lymph nodes were di- vided into 10 regions 6 groups according to the anatomic sites. The metastatic rate and dissected lymph nodes positive rate in these patients were compared. Results The total metastatic rate and the positive rate of dissected lymph nodes were 29.5% （38/129） and 6.8% （214/3 142） respective- ly. The metastatic rates of lymph node groups in these patients from higher to lower were as fol- lows： obturator （20.9%）, internal iliac （18. 6~）, external iliac （17. 1%）, common iliac （11.5%）, pre~ sacral （9.8~） and para-aortic （5.4%）, with a statistically significant difference in those groups （P~0.01）. The dissected lymph node positive rates from higher to lower were as follows., common iliac （10. 6~）, obtu- rator （10.0%）, external iliac （8.9%）, internal iliac （5.3%）, presacral （4. 0~/~） and para-aortic （1.6 ~/~0）, with a statistically significant difference in those groups （P~0.01）. Conclusions In the patients with bladder cancer. It is suggested that the optimal benchmark for radical cystectomy should include extensive pelvic lymph node dissection with anatomical boundaries including obturator, internal iliac, external iliac and common iliac nodes. The operation super-extended to para-aortic nodes may be in- dicated according to the result of sentinel lymph node biopsy in the presacral group is positive.