整块盆腔淋巴结清扫术在腹腔镜根治性膀胱切除中的应用(附40例报道)

Application of en-bloc pelvic lymphadenectomy in laparoscopic radical cystectomy(report of 40 cases)

目的:探讨腹腔镜根治性膀胱切除术中整块盆腔淋巴结清扫的手术方法和临床价值。方法:回顾性分析2013年2月~2015年2月行腹腔镜下根治性膀胱切除和改良后的整块盆腔淋巴结清扫术40例膀胱癌患者的临床病理资料。40例均为男性,年龄31~80岁,平均60.5岁。T1期2例,T2期19例,T3期13例,T4期6例。结果:所有患者都顺利实施了腹腔镜下手术,无中转开放病例。手术时间140~240min,平均185min。术中出血30~600ml,平均183ml,无输血病例。清扫淋巴结8~22枚,平均13.5枚,淋巴结阳性率为20.0%。术后出现淋巴瘘1例,2周后好转,无其他严重并发症发生。结论:腹腔镜下根治性膀胱切除术联合改进后的整块淋巴结清扫术,可有效避免血管损伤,出血少,保证盆腔淋巴结清扫的彻底性。

Objective:To investigate the surgical method and clinical value of en-bloc pelvic lymph node dissec-tion in laparoscopic radical cystectomy.Methods:Clinical and pathological data of 40 patients with bladder cancer un-dergoing laparoscopic radical cystectomy and modified en-bloc pelvic lymph nodes dissection from February 2013 to February 201 5 were analyzed retrospectively.All of the 40 patients were males.The mean age was 60.5 (31-80) years.Two patients were diagnosed as having T1 tumor,1 9 having T2 ,13 having T3 and 6 having T4 .Results:All the 40 patients underwent laparoscopic surgery successfully without any conversion to open procedure.The mean operative time was 185 (140-240)min.The mean blood loss was 183 (30-600)mL with no blood transfusion during surgery.Average 13.5 lymph nodes,ranging from 8 to 22,were removed during the operation with lymph node positive rate of 20.0%.One patient got postoperative lymphatic fistula and recovered in 2 weeks.There were no other serious perioperative complications. Conclusions:Laparoscopic radical cystectomy with modified en-bloc lymph node resection can reduce the risk of vas-cular injury and bleeding during the operation,and ensure the thoroughness of pelvic lymph node dissection.