盆腔淋巴结清扫在前列腺癌根治术中的应用

The application of pelvic lymphadenectomy in radical prostatectomy

目的 总结154例前列腺癌盆腔淋巴结清扫的作用和减少相关并发症体会。方法 154例前列腺癌,低危50例,中危38例,高危66例,在前列腺根治性切除前均行标准盆腔淋巴清扫,对病理证实淋巴结癌转移者给予6 M辅助内分泌治疗。结果 双侧盆腔淋巴清扫手术时间平均26（20-40）min,平均出血量20（10-100）mL,清扫淋巴结平均数6（3-20）枚,无大血管及闭孔神经损伤。盆腔淋巴结癌转移11例（7.1%）,低危,中危和高危前列腺癌发生淋巴结癌转移的几率分别为0例（0.0%）,1例（2.6%）和10例（15.2%）,其中10例获随访,3例术后6-10个月生化复发给予局部外放疗,平均随访81（44-150）个月,无生化复发,5例平均随访29.4（18-34）个月,PSA〈0.01,1例术后44个月发生骨转移行化疗,1例术后28个月因骨转移行双睾切除。结论 对局限性前列腺癌行盆腔淋巴清扫可以检出目前临床难以发现的癌转移淋巴结,有助于前列腺癌的准确分期和后续治疗。但盆腔淋巴清扫有一定并发症和增加手术时间。建议对低危前列腺癌可免于盆腔淋巴清扫,对中危和高危前列腺癌,尤其是高危前列腺癌应行标准或扩大盆腔淋巴清扫。

【Objective】To summarize the experience of pelvic lymphadenectomy in 154 cases of radical prostatectomy and to decrease the complications.【Methods】A total of 154 cases of prostate cancer, low risk 50, intermediate risk 38 and high risk 66 patients. The standard pelvic lymphadenectomy in the procedures of radical prostatectomywas performed. The patients were confirmed of lymph node metastasis by pathology underwent 6 months of hormonotherapy.【Result】The mean time of bilateral pelvic lymphadenectomy was 26（20-40） min, mean blood loss was20（10-100） mL, the numbers of resected lymph nodes were6（3-20） without main blood vessels or obturator nerve injury. 11（7.1%） cases had pelvic lymph nodes metastasis. In low, intermediate and high risk prostate prostate cancer,the lymph node metastatic rate was 0%, 2.6% and 15.2%, respectively. 10 cases were followed up. 3 caseswere biochemical recurrence in 6 -10 months after operation and underwent local beam radiotherapy. The mean follow up time was 81（44-150） months, no biochemical recurrence. 5 patients had 29.4（18-34） months of follow up, PSA〈0.01. 1 case had orchidectomy in 28 months due to bone metastasis. 1 case had chemotherapy 44 months after surgery due to bone metastasis. 【Conclusion】The pelvic lymphadenectomy could diagnose lymph node metastasis which can not be detected clinically in patients of local prostate cancer. It has advantages in cancer staging and following therapy. However, this procedure prolongs the operation time and has some complications. Avoiding pelvic lyphadenectomy is suggested in low risk prostate cancer. But, for the intermediate or high risk cancers, the standard or expanded pelvic lymphadenectomy should be performed, especially for the latter.