CAJ | 학술논문

目的探讨膀胱癌淋巴结转移特点及其在根治手术中合理施行盆腔淋巴结清扫术的临床意义. 方法收集1990年1月至2008年9月因膀胱癌行全膀胱切除术77例患者的临床病理资料.男58例,女19例.平均年龄57岁.术后TNM分期:T1 9例,T2 24例,T3 39例,T4 5例.常规将盆腔淋巴结分5组,比较各组转移率和阳性淋巴结检出率.转移率为发生淋巴结转移患者的例数占全部患者的百分比.阳性淋巴结检出率为转移淋巴结枚数占全部检取淋巴结总枚数的百分比. 结果全组淋巴结总转移率和阳性淋巴结检出率分别为27.3%(21/77)和14.8%(233/1576).各组转移率由高到低依次为闭孔、髂内、髂外、髂总和骶前,分别为19.5%(15/77)、19.3%(11/57)、13.7%(10/73)、5.3%(3/57)和3.8%(1/26),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依次为髂外、闭孔、髂总、髂内和骶前,分别为23.0%(83/361)、22.1%(103/467)、9.5%(17/179)、6.8%(28/411)和1.3%(2/158),差异有统计学意义(P<0.01).9例T1患者均无淋巴结转移. 结论膀胱癌行根治术时,对淋巴结转移率高的闭孔和髂内区域必须清扫,对阳性淋巴结检出率高的髂外和闭孔区域要完整清扫.根据术中闭孔、骶前的可疑淋巴结活检是否阳性,确定盆腔淋巴清扫范围.对非肌层浸润性膀胱癌患者不建议行淋巴结清扫术.
목적 탐토방광암림파결전이특점급기재근치수술중합리시행분강림파결청소술적림상의의. 방법수집1990년1월지2008년9월인방광암행전방광절제술77례환자적림상병리자료.남58례,녀19례.평균년령57세.술후TNM분기:T1 9례,T2 24례,T3 39례,T4 5례.상규장분강림파결분5조,비교각조전이솔화양성림파결검출솔.전이솔위발생림파결전이환자적례수점전부환자적백분비.양성림파결검출솔위전이림파결매수점전부검취림파결총매수적백분비. 결과전조림파결총전이솔화양성림파결검출솔분별위27.3%(21/77)화14.8%(233/1576).각조전이솔유고도저의차위폐공、가내、가외、가총화저전,분별위19.5%(15/77)、19.3%(11/57)、13.7%(10/73)、5.3%(3/57)화3.8%(1/26),차이유통계학의의(P<0.01).각조양성림파결검출솔유고도저의차위가외、폐공、가총、가내화저전,분별위23.0%(83/361)、22.1%(103/467)、9.5%(17/179)、6.8%(28/411)화1.3%(2/158),차이유통계학의의(P<0.01).9례T1환자균무림파결전이. 결론방광암행근치술시,대림파결전이솔고적폐공화가내구역필수청소,대양성림파결검출솔고적가외화폐공구역요완정청소.근거술중폐공、저전적가의림파결활검시부양성,학정분강림파청소범위.대비기층침윤성방광암환자불건의행림파결청소술.
Objective To evaluate the features of pelvic lymph node metastasis and the significance of lymph node dissection in bladder cancer patients treated with radical cystcetomy. Methods The data of 77 bladder cancer patients(58 males and 19 females with mean age of 57 yrs)treated with radical eystectomy and pelvic lymph node dissection from Jan. 1990 to Dec.2008 were analyzed retrospectively.Preoperative TNM staging showed stage T1 tumor of 9 cases,stage T2 of 24 cases,stage T3 of 39 eases and stage T4 of 5 cases.The pelvic lymph nodes were divided into 5 groups according to the anatomic sites.The metastatic rate and dissected lymph node positive rate in these patients were compared. Results The metastatic rate and dissected lymph node positive rate were 27.3%(21/77)and 14.8%(233/1576),respectively.The metastatic rate in these patients from higher to lower were as follows:obturator group 19.5%(15/77),internal iliac group 19.3%(11/57),external iliac group 13.7%(10/73),common iliac group 5.3%(3/57)and presacral group 3.8%(1/26),with a significant difference in those groups,P<0.01.The dissected lymph node positive rates from higher to lower were as follows:external iliac group 23.0%(83/361),obturator group 22.1% (103/467),common iliac group 9.5%(17/179),internal iliac group 6.8%(28/411)and presacral group 1.3 % (2/158), with a significant difference in those groups, P<0.01. There was no metastasis in 9 eases with stage T, tumor. Conclusions In the radical cystectomy for the treatment of bladder cancer, it is suggested that the regional lymph nodes with higher metastatic rate should he resected accordingly, and the group with a higher metastatic rate should be dissected completely. The operation extent may be adjusted according to the result of sentinel lymph node biopsy in the obturator or presacral groups. The pelvic lymphadenectomy is not suggested in the cases of stage T1 tumor.