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目的探讨膀胱癌淋巴结转移规律及其临床意义。方法收集因膀胱癌而行全膀胱切除术的129例患者的临床病理资料,按解剖部位将盆腔淋巴结分为10区6组,比较各组淋巴结转移率和阳性淋巴结检出率。结果全组淋巴结总转移率和阳性淋巴结检出率分别为29.5%(38/129)和6.8%(214/3142)。各组转移率由高到低排列为闭孔、髂内、髂外、髂总、骶前和肠系膜下动脉分叉以下腹主动脉及腔静脉周围,分别为20.9%、18.6%、17.1%、11.5%、9.8%和5.4%,差异有统计学意义(P<0.01)。各组阳性淋巴结检出率由高到低排列为髂总、闭孔、髂外、髂内、骶前和肠系膜下动脉分叉以下腹主动脉及腔静脉周围,分别为10.6%、10.0%、8.9%、5.3%、4.0%和1.6%,差异有统计学意义(P<0.01)。结论膀胱癌行根治性手术时,淋巴结清扫基本范围包括髂总动脉加标准盆腔淋巴结清扫。骶前和腹主动脉远端组若未发现可疑转移淋巴结者,该区域不必进行常规清扫。可根据手术所见,直接选取闭孔、骶前组淋巴结中的疑似转移者,行快速冷冻病理检查,明确有无肿瘤转移,决定是否缩小或超扩大盆腔淋巴结清扫术。
Objective To investigate the rule of lymph node metastasis in bladder cancer and its clinical significance. Methods The clinical data of 129 patients undergoing total cystectomy for bladder cancer were collected. The pelvic lymph nodes were divided into 6 groups according to anatomic sites. The lymph node metastasis rate and positive lymph node detection rate were compared between groups. Results The total lymph node metastasis rate and positive lymph node detection rate were 29.5% (38/129) and 6.8% (214/3142) respectively. The rates of metastasis from high to low in each group were 20.9%, 18.6%, 17.1%, respectively, in the peritoneal, iliac, external iliac, common iliac, presacral and inferior mesenteric artery branches below the abdominal aorta and vena cava, 11.5%, 9.8% and 5.4%, the difference was statistically significant (P <0.01). The detection rates of positive lymph nodes in each group were arranged in the order of 10.6%, 10.0%, respectively, below the abdominal aorta and vena cava below the bifurcation of common iliac, obturator, external iliac, iliac, presacral and inferior mesenteric artery, 8.9%, 5.3%, 4.0% and 1.6%, the difference was statistically significant (P <0.01). Conclusions In radical surgery of bladder cancer, the basic range of lymph node dissection includes common iliac artery plus standard pelvic lymph node dissection. If no suspicious metastatic lymph nodes are found in the presacral and distal abdominal aorta groups, there is no need for routine dissection in this area. According to the surgical findings, direct selection of obturator and presacral lymph nodes in the suspected metastasis line frozen rapid pathological examination, a clear tumor metastasis, decide whether to reduce or super-expand pelvic lymph node dissection.