根治性膀胱切除前后实施扩大盆腔淋巴结清扫对膀胱癌患者的影响

The clinical effect influence of expanding the pelvic lymph node cleaning before and after radical bladder resection implementation

目的：探讨根治性膀胱切除前后实施扩大盆腔淋巴结清扫对患者的影响。方法选择2010年1月～2013年12月我院泌尿外科收治的拟行根治性膀胱切除术和扩大盆腔淋巴结清扫术的膀胱癌患者为研究对象，采用随机数字表法将患者分成两组。术前清扫组（52例）采用在根治性膀胱切除术前实施扩大盆腔淋巴结清扫术；术后清扫组（54例）采用在根治性膀胱切除术后实施扩大盆腔淋巴结清扫术，术后统计两组患者术中以及术后并发症的发生比例以及手术时间。结果术前清扫组与术后清扫组扩大盆腔淋巴结清扫术所用时间差异无统计学意义[（82.5±13.7）min vs（78.6±13.1）min，P ＞0.05]，术前清扫组根治性膀胱切除术所用时间显著少于术后清扫组[（78.6±24.5）min vs（115.1±29.7）min，P ＜0.05]。术前清扫组髂内、髂前及盆腔总淋巴清除淋巴结个数显著少于术后清扫组[（5.4±2.3）个 vs（7.3±3.1）个，（1.4±1.0）个 vs（2.4±1.5）个，（25.6±8.3）个 vs（29.1±8.5）个，P ＜0.05]；术前清扫组和术后清扫组髂外、闭孔及腹膜后清除淋巴结个数差异无统计学意义[（4.1±2.0）个 vs（4.2±2.1）个，（5.4±2.1）个 vs（5.1±2.0）个，（4.5±1.2）个 vs（4.8±1.5）个，P ＞0.05]。术前清扫组和术后清扫组患者术中需输血、静脉损伤和淋巴瘘需延迟拔引流管发生率比较差异均无统计学意义[7.7％ vs 9.3％，5.8％ vs 3.7％，7.7％ vs 9.3％，P ＞0.05]。结论在对膀胱癌患者进行根治性膀胱切除术时，先实行扩大盆腔淋巴结清扫术的方式治疗膀胱癌患者具有手术时间短和淋巴结清扫个数少等特点，之后行根治性膀胱切除术时要再次确认髂前和髂内两区的淋巴结情况，出现可疑淋巴结时可进行二次清除，以提高患者的疗效情况。

Objective To explore the influence of expanding the pelvic lymph node cleaning before and after radical bladder resection implementation. Methods The bladder cancer patients performed by radical cystectomy and expand the pelvic lymph nodes from January 2010 to December 2013 in the department of urology of our hospital were selected as the observation object. They were divided into two groups by random number table,one group were used in radical cystectomy before the implementation of extended pelvic lymphadenectomy; another group were the implementation of extended pelvic lymphadenectomy in radical resection of thebladder, the intraoperative and postoperative complications proportion and operation time of two groups patients were compared after the surgery. Results The preoperative cleaning time spending much less radicalsurgery resection of bladder after dissection group [（78.6±24.5）min vs （115.1±29.7）min, P 〈 0.05]. The lymph node number before the iliac and iliac and total pelvic lymph removal of preoperative cleaning group was less than that of the after dissection group [（5.4±2.3） vs （7.3±3.1）, （1.4±1.0） vs （2.4±1.5）, （25.6±8.3） vs （29.1±8.5）, P 〈 0.05]. The lymph node number external iliac, obturator and cleared in retroperitoneal lymph node of preoperative cleaning group and after dissection group was significant difference [（4.1±2.0） vs （4.2±2.1）, （5.4±2.1） vs （5.1±2.0）, （4.5±1.2） vs （4.8±1.5）, P 〉 0.05]. The incidence of vein injury, lymphatic fistula delayed removal of drainage tube of two groups was no significant difference [7.7% vs 9.3 % , 5.8 % vs 3.7 % , 7.7 % vs 9.3 % , P 〉 0.05]. Conclusion The expanding the pelvic lymph node cleaning before and after radical bladder resection implementation is a better way, it has the characteristics of shorter operation time and less number. And then once again confirmed the iliac on screen and internal iliac lymph nodes in order to improve the curative effect of patients situation.