腹腔镜前列腺癌根治术中盆腔淋巴结清扫经验

摘要

目的:探讨腹腔镜前列腺癌根治术中盆腔淋巴结清扫的经验.方法:回顾分析2009年3月~2012年12月由同一主刀医师实施腹腔镜前列腺癌根治和盆腔淋巴结清扫手术的局限前列腺癌患者的临床资料,共41例.根据术前PSA、Gleason评分和临床分期对41例患者进行分组,统计分析各组淋巴结阳性率的差异.结果:腹腔镜盆腔淋巴清扫所占用的平均时间(35.0±5.8)min,平均出血量(42.7±19.9)ml,41例手术平均切除淋巴结数(6.9±1.8)个.前列腺特异抗原>20 μg/L和Gleason评分>7分组患者淋巴结阳性率为23.7%和20.0%,高于低危对照组,差异有统计学意义.引流管拔除时间>7 d的11例,占26.8%.结论:在高危的局限性前列腺癌患者中,淋巴结转移的比例较高,推荐对于这类病例采用腹腔镜前列腺癌根治手术的同时实施盆腔淋巴清扫.%Objective:To demonstrate the clinical experience with laparoscopic pelvic lymph node dissection for 41 prostate cancer patients.Methods:Between March 2009 and December 2012,the clinical data of 41 consecutive patients treated with laparoscopic radical prostatectomy and pelvic lymph node dissection by a single surgeon were analyzed retrospectively.All patients were divided into two groups according to preoperative PSA,Gleason score and clinical stage.The lymph node-positive ratio was compared between two groups statistically.Results:The average operative time was (35.0±5.8) min.The average estimated bleeding volume during lymphadenectomy was (42.7±19.9) mL.The average number of lymph nodes dissected was (6.9±1.8).The lymph node-positive ratio in PSA>20 μg/L group and Gleason score >7 group was 23.7% and 20.0% respectively,which was higher than in low-risk control group significantly.26.8% (11 cases) of patients had drainage more than 7 days.Conclusions:The lymph node-positive ratio was higher in high-risk clinically organ confined prostate cancer patients.Laparoscopic pelvic lymph node dissection was recommended to perform in those patients together with radical prostatectomy.