外侧入路三层面法在腹腔镜盆腔淋巴清扫中的应用
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摘要
【目的】评价外侧入路三层面法在盆腔淋巴清扫中的有效性及安全性。【方法】2016年9月至2017年12月,7例膀胱癌、4例高危前列腺癌及1例阴茎癌伴淋巴转移者,在行肿瘤根治时,按设计行外侧入路三层面法盆腔淋巴清扫术,分析基本资料、围手术期并发症、病理结果及生存状况。【结果】患者平均年龄为60.5(49~75)岁,手术均顺利完成,无改开放病例。平均手术时间为52(36~79)min,均出血量为45(25~110)mL。术后30 d内并发症ClavienⅠ-Ⅱ级8例,Ⅲ-Ⅴ级2例。平均清扫淋巴结18.5个,25.0%患者淋巴结阳性。【结论】外侧入路三层面法盆腔淋巴清扫术解剖清晰,安全可行,尤其对于肥胖患者更为合适,近期肿瘤控制良好,远期疗效有待更长期的大样本研究。
【Objective】To investigate the safety and efficacy of lateral three layers approach in pelvic lymph node dissection.【Methods】From September 2016 to December 2017,12 patients 7 with bladder cancer,4 with prostate cancer and 1 with penile cancer underwent pelvic lymph node dissection were enrolled. The information of patients,complications,pathologic characteristics,and survival data were analysed. 【Results】 The patient average age was 60.5(49~75) years. All operations were successful without conversion to open surgery. The average operation time was 52(36~79)min,and the bleeding volume was 45(25~110)mL. The postoperative complications within 30 days,Clavien Ⅰ-Ⅱ were 8 cases,Clavien Ⅲ-Ⅴ were 2 cases. The mean of lymph node dissection was 18.5,and lymph node positive percentage was 25.0%.【Conclusions】The lateral three layers approach in pelvic lymph node dissection was technically feasible. Our data has shown the recent oncological outcome is well. The outcome may need a long-term large sample study to further elaborate.
【Objective】To investigate the safety and efficacy of lateral three layers approach in pelvic lymph node dissection.【Methods】From September 2016 to December 2017,12 patients 7 with bladder cancer,4 with prostate cancer and 1 with penile cancer underwent pelvic lymph node dissection were enrolled. The information of patients,complications,pathologic characteristics,and survival data were analysed. 【Results】 The patient average age was 60.5(49~75) years. All operations were successful without conversion to open surgery. The average operation time was 52(36~79)min,and the bleeding volume was 45(25~110)mL. The postoperative complications within 30 days,Clavien Ⅰ-Ⅱ were 8 cases,Clavien Ⅲ-Ⅴ were 2 cases. The mean of lymph node dissection was 18.5,and lymph node positive percentage was 25.0%.【Conclusions】The lateral three layers approach in pelvic lymph node dissection was technically feasible. Our data has shown the recent oncological outcome is well. The outcome may need a long-term large sample study to further elaborate.
引文
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[8]李伟,张开颜,陈斌,等.根治性膀胱全切除术中分区与整块标准盆腔淋巴结清扫对淋巴结数目的影响[J].临床泌尿外科杂志,2016,31(4):349-356.Li W,Zhang KY,Chen B,et al.The evaluation ofseparate areas or enblock counting for the number oflymph nodes in standard pelvic lymph node dissec-tion during radical cystectomy[J].J clin urol,2016,31(4):349-356.
[9]Briganti A,Blute ML,Eastham JH,et al.Pelviclymph node dissection in prostate cancer[J].EurUrol,2009,55(3):1251-1265.
[10]Colicchia M,Sharma V,Abdollah F,et al.Thera-peutic value of standard versus extended pelviclymph node dissection during radical prostatectomyfor high-risk prostate cance[J].Curr Urol Rep,2017,18(7):1934-1937.
[11]Moschini M,Fossati N,Abdollah F,et al.Determi-nants of long-term survival of patients with locallyadvanced prostate cancer:the role of extensive pel-vic lymph node dissection[J].Prostate CancerProstatic Dis,2016,19(1):63-67.
[12]Heyns CF,Fleshner N,Sangar V,et al.Manage-ment of the lymph nodes in penile cancer[J].Urol-ogy,2010,76(1):S43-57.
[13]Li ZS,Deng CZ,Yao K,et al.Bilateral pelviclymph node dissection for Chinese patients with pe-nile cancer:a multicenter collaboration study[J].J Cancer Res Clin Oncol,2017,143(2):329-335.
[2]Burkhard FC,Studer UE.The role of lymphadenec-tomy in high risk prostate cancer[J].World JUrol,2008,26(3):231-236.
[3]Protzel C,Alcaraz A,Horenblas S,et al.Lymphad-enectomy in the surgical management of penile can-cer[J].Eur Urol,2009,55(5):1075-1088.
[4]Larcher A,Sun M,Schiffmann J,et al.Differen-tial effect on survival of pelvic lymph node dissec-tion at radical cystectomy for muscle invasive blad-der cancer[J].Eur J Surg Oncol,2015,41(3):353-360.
[5]Dhar NB,Klein EA,Reuther AM,et al.Outcomeafter radical cystectomy with limited or extendedpelvic lymph node dissection[J].J Urol,2008,179(3):873-878.
[6]Mills RD,Fleischmann A,Studer UE.Radical cys-tectomy with an extended pelvic lymphadenectomy:Rationale and results[J].Surg Oncol Clin N Am,2007,16(1):233-245.
[7]Bi LK,Huang H,Fan X,et al.Extended vs non-extended pelvic lymph node dissection and their in-fluence on recurrence-free survival in patients un-dergoing radical cystectomy for bladder cancer:Asystematic review and meta-analysis of comparative studies[J].BJU Int,2014,113(5b):E39-48.
[8]李伟,张开颜,陈斌,等.根治性膀胱全切除术中分区与整块标准盆腔淋巴结清扫对淋巴结数目的影响[J].临床泌尿外科杂志,2016,31(4):349-356.Li W,Zhang KY,Chen B,et al.The evaluation ofseparate areas or enblock counting for the number oflymph nodes in standard pelvic lymph node dissec-tion during radical cystectomy[J].J clin urol,2016,31(4):349-356.
[9]Briganti A,Blute ML,Eastham JH,et al.Pelviclymph node dissection in prostate cancer[J].EurUrol,2009,55(3):1251-1265.
[10]Colicchia M,Sharma V,Abdollah F,et al.Thera-peutic value of standard versus extended pelviclymph node dissection during radical prostatectomyfor high-risk prostate cance[J].Curr Urol Rep,2017,18(7):1934-1937.
[11]Moschini M,Fossati N,Abdollah F,et al.Determi-nants of long-term survival of patients with locallyadvanced prostate cancer:the role of extensive pel-vic lymph node dissection[J].Prostate CancerProstatic Dis,2016,19(1):63-67.
[12]Heyns CF,Fleshner N,Sangar V,et al.Manage-ment of the lymph nodes in penile cancer[J].Urol-ogy,2010,76(1):S43-57.
[13]Li ZS,Deng CZ,Yao K,et al.Bilateral pelviclymph node dissection for Chinese patients with pe-nile cancer:a multicenter collaboration study[J].J Cancer Res Clin Oncol,2017,143(2):329-335.