腹腔镜下膀胱癌根治术中膀胱切除前后标准淋巴结清扫效果比较

Standard lymph node dissection before and after laparoscopic cystectomy:a comparative study

目的观察在腹腔镜膀胱癌根治术中膀胱切除前后进行标准盆腔淋巴结清扫术(PLND)两种手术方案的相关临床指标变化。方法回顾性分析2018年1月至2019年5月长海医院接受腹腔镜膀胱癌根治术加标准淋巴结清扫的63例肌层浸润性膀胱癌(MIBC)患者的临床资料,其中男性54例,女性9例;年龄41~85岁,平均(66±9)岁。由2位不同的主刀医生分别实施先清扫淋巴结组(A组)和后清扫淋巴结组(B组)。统计术中及术后的相关临床指标,结果用t检验、非参数检验和卡方分析进行统计分析。结果两组的年龄、体质指数和肿瘤分期等术前基线指标无统计学差异。A、B组清扫淋巴结总数分别为11.3±5.8和13.6±5.1(P>0.05),阳性淋巴结检出率分别为15.6%(5/32)和22.6%(7/31,P>0.05),并发症发生率分别为9.4%(3/32)和3.2%(1/31,P>0.05);术中出血量和手术前后血红蛋白、白蛋白以及肌酐变化值等无统计学差异(P>0.05)。结论腹腔镜下膀胱癌根治术在膀胱切除前后行标准PLND在淋巴结清扫数量、术后临床指标变化方面两组无显著性差异,两种手术方式在熟练掌握手术技巧后均安全、有效。

Objective To explore the clinical and pathological outcomes of standard pelvic lymph node dissection(PLND)before and after radical cystectomy(RC).Methods A retrospective analysis was performed on 63 patients with muscle-invasive bladder cancer(MIBC) who received RC and PLND in our hospital from Jan.2018 to May 2019.The patients included 54 males and 9 females,and age ranged from 41 to 85 years,average(66±9) years.PLND before RC(group A) and after RC(group B) were performed by two surgeons respectively.Relevant intraoperative and postoperative parameters were collected and analyzed with t test,non-parametric test and chi-square analysis.Results There were no significant differences in age,body mass index,tumor stage,intraoperative blood loss,hemoglobin,albumin and creatinine between the two groups(P>0.05).The total number of dissected lymph nodes in group A and group B were 11.3±5.8 and 13.6±5.1,respectively(P=0.096),respectively;rates of positive lymph node were 15.6%(5/32) and 22.6%(7/31)(P=0.482);incidences of complications were 9.4 %(3/32) and 3.2%(1/31)(P=0.628),respectively.Conclusion Standard PLND before and after RC had no significant difference in terms of the number of lymph node dissected and changes of postoperative clinical parameters.Both surgical approaches are safe and effective with skilled surgeons.