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目的:探讨腹腔镜前列腺癌根治术中盆腔淋巴结清扫的经验。方法:回顾分析2009年3月~2012年12月由同一主刀医师实施腹腔镜前列腺癌根治和盆腔淋巴结清扫手术的局限前列腺癌患者的临床资料,共41例。根据术前PSA、Gleason评分和临床分期对41例患者进行分组,统计分析各组淋巴结阳性率的差异。结果:腹腔镜盆腔淋巴清扫所占用的平均时间(35.0±5.8)min,平均出血量(42.7±19.9)ml,41例手术平均切除淋巴结数(6.9±1.8)个。前列腺特异抗原>20μg/L和Gleason评分>7分组患者淋巴结阳性率为23.7%和20.0%,高于低危对照组,差异有统计学意义。引流管拔除时间>7d的11例,占26.8%。结论:在高危的局限性前列腺癌患者中,淋巴结转移的比例较高,推荐对于这类病例采用腹腔镜前列腺癌根治手术的同时实施盆腔淋巴清扫。
Objective: To explore the experience of pelvic lymph node dissection during laparoscopic radical prostatectomy. Methods: A retrospective analysis of March 2009 ~ December 2012 by the same chief physician in the implementation of laparoscopic radical prostatectomy and pelvic lymph node dissection in patients with localized prostate cancer clinical data, a total of 41 cases. According to preoperative PSA, Gleason score and clinical stage, 41 patients were divided into groups, and statistical analysis was made on the difference of lymph node positive rate in each group. Results: The mean duration of laparoscopic pelvic lymphadenectomy was (35.0 ± 5.8) min, the average amount of bleeding was (42.7 ± 19.9) ml, and the average number of resected lymph nodes in 41 cases was 6.9 ± 1.8. The positive rates of lymph node in patients with prostate specific antigen> 20μg / L and Gleason score> 7 were 23.7% and 20.0%, respectively, which were higher than those in low-risk control group, the difference was statistically significant. Drainage tube removal time> 7d in 11 cases, accounting for 26.8%. CONCLUSION: In high-risk patients with localized prostate cancer, a higher proportion of lymph node metastases is recommended for pelvic lymphadenectomy with laparoscopic radical prostatectomy in these cases.