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中华腔镜泌尿外科杂志(电子版)

中华腔镜泌尿外科杂志(电子版) ›› 2018, Vol. 12 ›› Issue (06) : 397 -401. doi: 10.3877/cma.j.issn.1674-3253.2018.06.009

所属专题： 文献；

临床研究

膀胱癌盆腔淋巴结转移的规律及影响因素分析
谢伟槟1, 刘皓1, 孔坚秋1, 苏扬帆1, 毕峻铭1, 董文1, 林天歆1, 黄健1,†()   
  1. 1. 510120　广州，中山大学孙逸仙纪念医院泌尿外科
  • 收稿日期:2016-10-02 出版日期:2018-12-01
  • 通信作者: 黄健
  • 基金资助:
    广东省医学科学技术研究基金(A2018388); 广东省科技发展专项资金(2017B020227007); 广东省自然科学基金(2016A030313244); 广州市科技计划项目(201604020177); 逸仙临床研究培育项目(SYS-Q-201703)

Pattern and risk factors of lymph node metastasis in patients undergoing laparoscopic radical cystectomy and lymph node dissection for bladder cancer

Weibin Xie1, Hao Liu1, Jianqiu Kong1, Yangfan Su1, Junming Bi1, Wen Dong1, Tianxin Lin1, Jian Huang1,†()   

  1. 1. Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
  • Received:2016-10-02 Published:2018-12-01
  • Corresponding author: Jian Huang
  • About author:
    Corresponding author: Huang Jian, Email:
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引用本文：

谢伟槟, 刘皓, 孔坚秋, 苏扬帆, 毕峻铭, 董文, 林天歆, 黄健. 膀胱癌盆腔淋巴结转移的规律及影响因素分析[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2018, 12(06): 397-401.

Weibin Xie, Hao Liu, Jianqiu Kong, Yangfan Su, Junming Bi, Wen Dong, Tianxin Lin, Jian Huang. Pattern and risk factors of lymph node metastasis in patients undergoing laparoscopic radical cystectomy and lymph node dissection for bladder cancer[J/OL]. Chinese Journal of Endourology(Electronic Edition), 2018, 12(06): 397-401.

目的

通过分析膀胱尿路上皮癌淋巴结转移的规律及其相关影响因素，结合盆腔淋巴清扫的研究进展，探讨盆腔淋巴清扫策略。

方法

收集我院2008年至2016年由同一术者完成腹腔镜根治性膀胱切除和盆腔淋巴清扫的膀胱尿路上皮癌患者的资料，回顾性分析淋巴结转移的规律及其相关影响因素。

结果

共收集患者285例，69例（24.2%）发生淋巴结转移。最常见的淋巴结转移部位为髂内/闭孔淋巴结（57/69，82.6%），其次是髂外淋巴结（37/69，53.6%）；真骨盆外淋巴结转移均伴随髂内/闭孔或髂外淋巴结转移；单侧壁膀胱癌可以向对侧盆腔淋巴结转移。T1组淋巴结转移率4.6%（4/87），T2组18.0%（18/100）；T3组50.8%（30/59）；T4组68.0%（17/25）。多因素回归分析显示淋巴结转移与肿瘤分期呈正相关，与分级、年龄、性别、体质量指数、吸烟等因素无关。

结论

髂内/闭孔和髂外淋巴结是膀胱癌最主要的淋巴结转移部位，肿瘤高分期是影响膀胱癌淋巴结转移的主要因素。根治性膀胱切除术应行至少包括双侧髂内、闭孔、髂外淋巴结的标准淋巴清扫。

关键词: 膀胱癌, 腹腔镜, 膀胱切除术, 淋巴清扫
Objective

To investigate the pattern and risk factors of pelvic lymph node metastasis in patients with bladder cancer treated with laparoscopic radical cystectomy and pelvic lymphadenectomy.

Methods

Data of 285 patients underwent laparoscopic radical cystectomy and pelvic lymphadenectomy in our hospital from 2008 to 2016 by the same surgeon was retrospectively collected. The characteristics and risk factors of lymph node metastasis were analyzed.

Results

285 patients (24.2%) had lymph node metastasis. The most common site of lymph node metastasis was the internal iliac/obturator lymph node (57/69, 82.6%), followed by the external iliac lymph node (37/69, 53.6%). External pelvic lymph node metastasis was accompanied by true pelvic lymph node metastasis. Tumor location and lymph node metastasis were significantly correlated. However, lymphatic drainage from the bladder seemed to be bilateral. The incidence in different stages: 4.6% (4/87) in T1, 18.0% (18/100) in T2, 50.8% (30/59) in T3, 68.0% (17/25) in T4. The incidence of lymph node metastasis was positively correlated with tumor stage.

Conclusion

The most common lymph node metastases in bladder cancer are the internal iliac/obturator and external iliac lymph nodes. Radical cystectomy should be performed with lymphadenectomy including at least bilateral internal iliac, obturator and external iliac lymph nodes.

Key words: Urinary bladder neoplasms, Laparoscopy, Cystectomy, Lymphadenectomy
表1 膀胱癌患者的临床病例资料
项目 例（%）
性别 ?
? 男 242（84.9）
? 女 043（15.1）
分期 ?
? pTa 07（2.5）
? pTis 07（2.5）
? pT1 087（30.5）
? pT2 100（35.1）
? pT3 059（20.7）
? pT4 25（8.8）
分级 ?
? 低级别/G1+G2 043（15.1）
? 高级别/G3 242（84.9）
淋巴结分期 ?
? pN0 216（75.8）
? pN1 27（9.5）
? pN2 033（11.6）
? pN3 09（3.2）
表2 膀胱癌临床病理特征与淋巴结转移状态的关系
变量 单因素分析 多因素分析
OR（95%CI） P值 OR（95%CI） P值
年龄（>65 vs ≤65岁） 1.24（0.72-2.13） 0.446 ? ?
性别（女vs男） BMI（≥24 vs <24 kg/m2） 0.46（0.19-1.14） 0.095 ? ?
0.73（0.41-1.31） 0.288 ? ?
吸烟史（是vs否） 1.48（0.41-1.31） 0.166 ? ?
三角区肿瘤（是vs否） 0.86（0.47-1.58） 0.622 ? ?
分期 ? ? ? ?
? <T2 Ref ? ? ?
? T2 7.49（0.47-1.58） <0.010 4.65（1.50-14.43） <0.010
? >T2 041.07（12.04-140.1） <0.001 25.55（9.79-117.77） <0.001
分级 ? ? ? ?
? 低级别（G1+G2） Ref ? ? ?
? 高级别（G3） 7.85（1.85-33.36） <0.01 2.87（0.61-13.43） 0.182
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