摘要目的 探讨根治性膀胱切除前后实施扩大盆腔淋巴结清扫(e-PLND)对疗效的影响.方法 回顾性分析2003年1月至2013年1月浙江大学金华医院泌尿外科行e-PLND+全膀胱切除术且具备完整病理资料的107例膀胱癌患者.男94例,女13例,平均年龄(62±10)岁.盆腔淋巴结清扫术按解剖部位将盆腔淋巴结分为10区6组进行.根据手术方式的不同进行分组:e-PLND后再行膀胱全切术(A组)47例;膀胱全切后再行e-PLND(B组)60例.比较两组手术时间、清除的淋巴结数目、淋巴结转移率、阳性淋巴结检出率和并发症等.结果比较采用X2检验和t检验.结果 临床及病理特征两组分布均衡(P＞0.05).A、B两组e-PLND时间分别为(83±27)与(78±24) min(P＞0.05),差异无统计学意义.A、B两组切除膀胱的手术时间分别为(79±41)与(113±44) min(P＜0.01);清除淋巴结数目分别为(25.5±9.7)与(29.0±8.4)枚(P＜0.05),其中髂内区域分别为(5.7±2.9)与(7.2±3.5)枚(P＜0.05),骶前区域分别为(1.3±1.1)与(2.5±1.6)枚(P＜0.01),差异均有统计学意义.淋巴结转移率两组分别为34.0％ (16/47)与31.7％ (19/60)(P＞0.05);阳性淋巴结检出率分别为9.0％ (108/1197)与7.5％(130/1743)(P＞0.05);并发症总发生率分别为23.4％ (11/47)与20.0％ (12/60)(P＞0.05),差异均无统计学意义.结论 膀胱癌行根治性手术时,盆腔淋巴结清扫术后再行膀胱全切术较优.但膀胱全切后,须对髂内及骶前区域的淋巴结进行认真核查,必要时这2个区域要补充清扫.

abstractsObjective To explore the efficacies of extended pelvic lymph node dissection (e-PLND) before or after radical cystectomy (RC).Methods From January 2003 to January 2013,a total of 107 patients underwent e-PLND plus RC.And their relevant clinical data were reviewed.Their median age was (62 ± 10) years.The e-PLND were divided into 10 regions and 6 groups according to the anatomic sites.Forty-seven (43.9％) underwent RC after e-PLND (group A) and 60 (56.1％) had RC before e-PLND (group B).Two groups were compared for operative duration,numbers of lymph nodes removed,metastatic rates of lymph node,dissected lymph node positive rates and operative complications.The results were analyzed with Chi-square or Student's test.Results Clinicopathological characteristics were comparable for two groups (P ＞ 0.05).The mean operative durations of e-PLND were similar in both groups ((83 ±27)vs(78 ±24) min,P ＞0.05).The mean operative durations of RC were significantly shorter in group A than those in group B ((79 ± 41) vs (113 ± 44) min,P ＜ 0.01).The mean number of lymph nodes removed (25.5 ± 9.7 vs 29.0 ± 8.4) and the mean number of lymph nodes removed at internal iliac (5.7 ±2.9 vs 7.2 ±3.5)and presacral(1.3 ± 1.1 vs 2.5 ± 1.6) regions were significantly fewer in group A than those in group B (all P ＜ 0.05).The metastatic rates of lymph node (34.0％ (16/47) vs 31.7％ (19/60)),dissected lymph node positive rates (9.0％ (108/1197) vs 7.5％ (130/1743)) and operative complications (23.4％ (11/47) vs 20.0％ (12/60)) were similar in both groups (all P ＞ 0.05).Conclusion RC is performed preferably after e-PLND,and internal iliac and presacral area should be dissected for additional lymph nodes after RC.