中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2013年
32期
2574-2577
,共4页
朱再生%叶敏%施红旗%周一波%陈良佑%刘全启%张春霆%罗荣利%徐礼臻
硃再生%葉敏%施紅旂%週一波%陳良祐%劉全啟%張春霆%囉榮利%徐禮臻
주재생%협민%시홍기%주일파%진량우%류전계%장춘정%라영리%서례진
膀胱肿瘤%膀胱切除术%淋巴结切除术
膀胱腫瘤%膀胱切除術%淋巴結切除術
방광종류%방광절제술%림파결절제술
Urinary bladder neoplasms%Cystectomy%Lymph node excision
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.
目的 探討根治性膀胱切除前後實施擴大盆腔淋巴結清掃(e-PLND)對療效的影響.方法 迴顧性分析2003年1月至2013年1月浙江大學金華醫院泌尿外科行e-PLND+全膀胱切除術且具備完整病理資料的107例膀胱癌患者.男94例,女13例,平均年齡(62±10)歲.盆腔淋巴結清掃術按解剖部位將盆腔淋巴結分為10區6組進行.根據手術方式的不同進行分組:e-PLND後再行膀胱全切術(A組)47例;膀胱全切後再行e-PLND(B組)60例.比較兩組手術時間、清除的淋巴結數目、淋巴結轉移率、暘性淋巴結檢齣率和併髮癥等.結果比較採用X2檢驗和t檢驗.結果 臨床及病理特徵兩組分佈均衡(P>0.05).A、B兩組e-PLND時間分彆為(83±27)與(78±24) min(P>0.05),差異無統計學意義.A、B兩組切除膀胱的手術時間分彆為(79±41)與(113±44) min(P<0.01);清除淋巴結數目分彆為(25.5±9.7)與(29.0±8.4)枚(P<0.05),其中髂內區域分彆為(5.7±2.9)與(7.2±3.5)枚(P<0.05),骶前區域分彆為(1.3±1.1)與(2.5±1.6)枚(P<0.01),差異均有統計學意義.淋巴結轉移率兩組分彆為34.0% (16/47)與31.7% (19/60)(P>0.05);暘性淋巴結檢齣率分彆為9.0% (108/1197)與7.5%(130/1743)(P>0.05);併髮癥總髮生率分彆為23.4% (11/47)與20.0% (12/60)(P>0.05),差異均無統計學意義.結論 膀胱癌行根治性手術時,盆腔淋巴結清掃術後再行膀胱全切術較優.但膀胱全切後,鬚對髂內及骶前區域的淋巴結進行認真覈查,必要時這2箇區域要補充清掃.
목적 탐토근치성방광절제전후실시확대분강림파결청소(e-PLND)대료효적영향.방법 회고성분석2003년1월지2013년1월절강대학금화의원비뇨외과행e-PLND+전방광절제술차구비완정병리자료적107례방광암환자.남94례,녀13례,평균년령(62±10)세.분강림파결청소술안해부부위장분강림파결분위10구6조진행.근거수술방식적불동진행분조:e-PLND후재행방광전절술(A조)47례;방광전절후재행e-PLND(B조)60례.비교량조수술시간、청제적림파결수목、림파결전이솔、양성림파결검출솔화병발증등.결과비교채용X2검험화t검험.결과 림상급병리특정량조분포균형(P>0.05).A、B량조e-PLND시간분별위(83±27)여(78±24) min(P>0.05),차이무통계학의의.A、B량조절제방광적수술시간분별위(79±41)여(113±44) min(P<0.01);청제림파결수목분별위(25.5±9.7)여(29.0±8.4)매(P<0.05),기중가내구역분별위(5.7±2.9)여(7.2±3.5)매(P<0.05),저전구역분별위(1.3±1.1)여(2.5±1.6)매(P<0.01),차이균유통계학의의.림파결전이솔량조분별위34.0% (16/47)여31.7% (19/60)(P>0.05);양성림파결검출솔분별위9.0% (108/1197)여7.5%(130/1743)(P>0.05);병발증총발생솔분별위23.4% (11/47)여20.0% (12/60)(P>0.05),차이균무통계학의의.결론 방광암행근치성수술시,분강림파결청소술후재행방광전절술교우.단방광전절후,수대가내급저전구역적림파결진행인진핵사,필요시저2개구역요보충청소.
Objective 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.