荧光腹腔镜在中高危局限型前列腺癌患者盆腔淋巴结清扫术中的临床价值

Clinical value of fluorescence laparoscopy in pelvic lymph node dissection for intermediate-and high-risk prostate cancer patients

目的:探索荧光腹腔镜在中高危局限型前列腺癌患者行根治性前列腺切除+盆腔淋巴结清扫术的临床价值。方法:回顾性分析了2018~2020年在我院行荧光腹腔镜下根治性前列腺切除+盆腔淋巴结清扫术的中高危局限型前列腺癌患者。通过术前半小时在膀胱镜下对前列腺两侧叶注射造影剂(吲哚氰绿)1 ml,术中采用荧光腹腔镜观察显影淋巴结,对入组患者进行闭孔旁、髂外动脉旁、髂内动脉旁、髂总动脉旁及骶前淋巴结清扫、标记、送检,分部位记录每例患者的淋巴结数量、荧光显影淋巴结数量、阳性淋巴结数量。结果:45例患者纳入本次研究,包含32例中危局限型前列腺癌患者和13例高危局限型前列腺患者,术后病理Gleason评分为(7.5±0.7)分,一共清扫出967枚淋巴结。其中42例患者在荧光腹腔镜下可观察到显影淋巴结,共显影134枚淋巴结。有5例患者发现阳性淋巴结,共14枚阳性淋巴结。4例患者在髂外动脉旁、髂内动脉旁及闭孔旁淋巴结部位检出阳性淋巴结,检出效率为:灵敏性80%、特异性100%。3例患者在荧光显影的淋巴结、淋巴管部位检出阳性淋巴结,检出效率为:灵敏性60%、特异性100%。同时清扫外动脉旁、髂内动脉旁及闭孔旁淋巴结及荧光显影的淋巴结,发现5例阳性淋巴结患者,检出效率为:灵敏性100%、特异性100%。结论:荧光腹腔镜在多数前列腺癌患者中可以观察到显影的盆腔淋巴结。在中高危局限型前列腺癌患者中清扫闭孔旁淋巴结+髂外动脉旁淋巴结+髂内动脉旁淋巴结+荧光显影的淋巴群,可以取得较好的阳性淋巴结检出率。

Objective:We explore the clinical value of fluorescence laparoscopy in the management of intermediate-and high-risk prostate cancer(PCa)patients by radical prostatectomy plus pelvic lymph node dissection(RP+PLND).Methods:We retrospectively analyzed the clinical data on 45 PCa patients(32 intermediate-and 13 high-risk cases)treated by RP+PLND in our hospital from 2018 to 2020.The patients received injection of 1 ml Indocyanine Green bilaterally into the prostate under the cystoscope 30 minutes before surgical dissection of the lymph nodes,including those by the external iliac,distal internal iliac and obturator,common and presacral ones,and those visualized in the fluorescence image.We recorded the total numbers of lymph nodes,the fluorescence-manifested ones,and the positive ones.Results:The mean postoperative Gleason score of the patients was 7.5±0.7.Totally 967 lymph nodes were removed,and 134 were observed under the fluorescence laparoscope in 42 cases.Fourteen positive lymph nodes were found in 5 cases.Positive lymph nodes were also detected by the external iliac,distal internal iliac and obturator in 4 cases,with a sensitivity of 80%and a specificity of 100%.Fluorescence imaging exhibited positive lymph nodes in the lymphangion in 3 cases,with a sensitivity of 60%and a specificity of 100%.The lymph nodes by the external iliac,distal internal iliac and obturator and the fluorescence-manifested ones were also dissected,which were found positive in 5 cases,with a sensitivity of 100%and a specificity of 100%.Conclusion:Pelvic lymph nodes can be observed by fluorescence laparoscopy in most PCa patients.Dissection of the lymph nodes by the external iliac,distal internal iliac and obturator and the fluorescence-manifested ones contributes to a higher detection rate of positive pelvic lymph nodes in intermediate-and high-risk PCa patients.