腹腔镜盆腔淋巴结清扫术治疗前列腺癌35例临床分析

Laparoscopic Pelvic Lymph Node Dissection for Prostate Cancer:a Clinical Analysis of 35 Cases

目的评价腹腔镜盆腔淋巴结清扫术在前列腺癌治疗中的意义。方法对2012年6月至2019年11月在南昌大学第四附属医院行腹腔镜盆腔淋巴结清扫术治疗的35例前列腺癌患者的临床资料进行回顾分析,其中21例转移低中风险患者(A组)行腹腔镜局限性盆腔淋巴结清扫术,14例转移高风险患者(B组)行腹腔镜标准盆腔淋巴结清扫术。比较2组盆腔淋巴结清扫数目、阳性淋巴结数、手术时间、术中出血量、术后肠功能恢复时间、住院总费用及术后住院时间。结果35例患者均手术成功,无中转开放病例,无闭孔神经损伤等并发症,术后病理检查均发现淋巴结。B组清扫淋巴结数、阳性淋巴结数及手术时间均显著高于A组(均P<0.05);2组术中出血量、术后胃肠功能恢复时间、术后住院时间、住院总费用比较差异均无统计学意义(均P>0.05)。结论盆腔淋巴结清扫术是前列腺癌淋巴结转移诊断的金标准,准确的淋巴结分期将有助于临床医生准确判断复发高危患者并及时使用辅助治疗,对转移高风险患者,行标准或扩大的淋巴结清扫术较为适合。

Objective To evaluate the significance of laparoscopic pelvic lymph node dissection in the treatment of prostate cancer.Methods A retrospective analysis was performed on 35 patients with prostate cancer who underwent laparoscopic pelvic lymph node dissection in the Fourth Affiliated Hospital of Nanchang University from June 2012 to November 2019.Among them,21 low-and medium-risk patients for metastasis(group A)received limited pelvic lymph node dissection,and 14 high-risk patients for metastasis(group B)received standard laparoscopic pelvic lymph node dissection.The number of dissected lymph nodes,number of positive lymph nodes,operative time,intraoperative blood loss,postoperative recovery time of intestinal function,total hospitalization costs,and postoperative hospital stay were compared between the two groups.Results All patients successfully completed operation without obturator nerve injury and other complications,and no cases were converted to open surgery.Postoperative pathological examination showed lymph nodes in all cases.Compared with group A,the number of dissected lymph nodes,number of positive lymph nodes and operative time significantly increased in group B(all P<0.05).There were no significant differences between the two groups in intraoperative blood loss,postoperative recovery time of intestinal function,total hospitalization costs,and postoperative hospital stay(all P>0.05).Conclusion Laparoscopic pelvic lymph node dissection is the gold standard for the diagnosis of lymph node metastasis in prostate cancer.Accurate lymph node staging can help clinicians to accurately determine the recurrence and to timely perform adjuvant therapy.The standard or extended lymph node dissection is preferred in high-risk patients for metastasis.