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目的:探讨对膀胱癌患者扩大淋巴结清扫术的意义并分析影响膀胱癌复发的相关因素。方法:收集2008年3月~2012年7月由同一组术者施行的腹腔镜膀胱癌根治术(LRC)75例患者资料,排除术前/术后有放化疗史患者。其中扩大淋巴结清扫33例,标准清扫42例,比较两组无病生存率的差异。为避免手术学习曲线影响,在手术和并发症方面仅比较两组2010年2月之后病例(53例)的情况。结果:手术方面,2010年2月之后的扩大清扫组共31例平均清扫淋巴结(20.30±6.66)个,同期标准组共22例平均清扫(13.95±6.49)个(P<0.05),两组平均手术时间、术中出血量和术后并发症发生的差异无统计学意义。预后方面,两组全部患者(75例)的无病生存率(DFS)差异无统计学意义(P=0.081),扩大清扫组(33例)6、12、18、24个月DFS分别为93%、89%、84%、77%,标准清扫组(42例)相应数据为85%、76%、62%、59%。淋巴结阳性患者扩大清扫组DFS明显高于标准清扫组(P=0.048)。结论:扩大淋巴结清扫可以提高淋巴结阳性患者的DFS,对手术时间、出血量、术后并发症等无显著影响,值得应用和推广。淋巴结清扫范围是影响膀胱癌复发的重要因素。
Objective: To explore the significance of expanding lymph node dissection in patients with bladder cancer and analyze the related factors that affect the recurrence of bladder cancer. Methods: The data of 75 cases of laparoscopic radical mastectomy (LRC) performed by the same group of surgeons from March 2008 to July 2012 were collected, and the patients with preoperative and postoperative chemoradiation were excluded. Among them, 33 cases were expanded lymphadenectomy, and 42 cases were cleaned up by standard method. The difference of disease-free survival rate was compared between the two groups. To avoid the impact of the surgical learning curve, only two cases of post-February 2010 cases (n = 53) were compared in terms of surgery and complications. Results: In terms of operation, there were 31 cases of dissection lymph nodes (20.30 ± 6.66) in the extended dissection group after February 2010, with a mean of 22 cases (13.95 ± 6.49) in the standard group (P <0.05) There was no significant difference in operative time, intraoperative blood loss and postoperative complications. In terms of prognosis, there was no significant difference in the disease-free survival (DFS) between the two groups (75 cases) (P = 0.081), and the DFS in the extended group (33 cases) at 6,12,18,24 months were 93 %, 89%, 84% and 77% respectively. The corresponding data of the standard cleaning group (42 cases) were 85%, 76%, 62% and 59% respectively. DFS in patients with lymph node-positive enlargement was significantly higher than that in the standard dissection group (P = 0.048). Conclusion: Expanding lymph node dissection can improve DFS in patients with lymph node positive, which has no significant effect on operation time, blood loss, postoperative complications and so on. It is worth to apply and popularize. The extent of lymph node dissection is an important factor affecting the recurrence of bladder cancer.