盆腔淋巴结计数的应用解剖学研究及其临床意义

Applied anatomy study of pelvic lymph node count and its clinical significance

目的 探讨根治性膀胱全切术中盆腔不同清扫范围内淋巴结的清扫数目作为衡量盆腔淋巴结清扫（PLND）手术质量标准的可行性.方法 在19具成人尸体标本上模拟行超扩大PLND术,并将范围分为标准、扩大、超扩大3级及10个解剖区域,对每个区域淋巴结分别清扫及计数.计算超扩大、扩大和标准清扫解剖区域之内清除的淋巴结总数目及其变异系数（CV）.结果 超扩大PLND术产生的淋巴结数目29~72个,平均（46.1±12.5）个;扩大清扫为23~69个,平均（41.3±10.8）个;标准清扫为18~39个,平均（28.9±7.2）个;CV分别为27.2%、26.2%与25.1%.结论 盆腔各解剖区域淋巴结数目存在较大的个体差异.在根治性膀胱切除术中,应用最低淋巴结计数作为衡量PLND手术质量标准的合理性和可行性需进一步探讨.

Objective To determine the number, variability and distribution of pelvic lymph nodes to better understand the utility of the node count as a surrogate for the dissection extent at radical cystectomy for bladder cancer.Methods Super-extended pelvic lymph node dissection （PLND） was performed on 19 human cadavers, and the lymph nodes within each of 10 dissection zones were enumerated respectively .The mean, standard deviation and range of nodal yield within each dissection region were calculated .The super-extended and standard dissection templates were compared using the paired t test .The coefficient of variation （CV） were 27.2%, 26.2% and 25.1% respectively.Results Super-extended PLND yielded a mean of 46.1 ±12.5 lymph nodes, with a total node count range of 29 -72 nodes.Extended PLND yielded a mean of 41.3 ±10.8 lymph nodes, with a total node count range of 23 -69 nodes.In contrast, the nodal yield within the standard template was 28.9 ±7.2 lymph nodes, nodes with a range of 18 -39 nodes. Conclusions There are substantial interindividual differences about the lymph nodes counts in the pelvic cavity.These results have demonstrated the further exploration of lymph node count as a surrogate for the dissection extent.