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高危前列腺癌患者行机器人辅助腹腔镜盆腔淋巴结清扫——清扫现状及淋巴清扫意义再认识

Robot-assisted laparoscopic pelvic lymph node dissection for high-risk prostate cancer: Status quo and re-recognition of the strategy

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【作者】 张连栋李和程付德来种铁

【Author】 ZHANG Lian-dong;LI He-cheng;FU De-lai;ZHONG Tie;Department of Urology, the Second Affiliated Hospital of Xi’an Jiaotong University;

【通讯作者】 种铁;

【机构】 西安交通大学第二附属医院泌尿外科

【摘要】 目的:探讨机器人辅助腹腔镜下扩大盆腔淋巴结清扫对高危前列腺癌患者的临床意义,并分析清扫现状及淋巴清扫意义。方法:纳入2020年4月至2023年1月29例高危前列腺癌患者,均行机器人辅助腹腔镜下根治性前列腺切除术及扩大盆腔淋巴结清扫,收集患者一般资料,分析淋巴结清扫情况及术后并发症发生情况,并回顾相关文献探讨淋巴清扫的意义。结果:29例高危前列腺癌患者,年龄(69.3±6.6)岁,术前PSA 8.43~434μg/L,术前Gleason评分6分1例,7分9例,≥8分19例;扩大盆腔淋巴结清扫手术时间(97.2±15.7) min,出血量(30.5±11.2) ml。清扫淋巴结数目3~42枚,中位数为13枚,其中≤10枚10例,11~19枚12例,≥20枚7例;盆腔淋巴结阳性13例,阳性率44.8%;阳性淋巴结中位数4枚。切缘阳性患者11例,占37.9%;淋巴血管浸润(LVI)4例(13.8%),神经浸润(PNI)4例(13.8%)。切缘阳性与淋巴转移存在显著相关性(P<0.05),LVI、PNI情况及年龄分布与淋巴结转移情况未见显著性相关性(P>0.05)。术中未发生重要血管及神经损伤等情况。术后Gleason评分6分1例,7分7例,≥8分21例。结论:机器人辅助腹腔镜下扩大盆腔淋巴结清扫是治疗高危前列腺癌的重要方式,有助于对前列腺癌患者进行准确病理分期,但是否能使高危前列腺癌患者生存获益,目前尚缺乏证据,仍需进一步随访明确其治疗效果。

【Abstract】 Objective: To explore the clinical significance of extended pelvic lymph node dissection(EPLND) under the robot-assisted laparoscope in the treatment of high-risk PCa. Methods: This study included 29 cases of high-risk PCa treated by robot-assisted laparoscopic radical prostatectomy and EPLND from April 2020 to January 2023. We collected the general data on the patients, recorded the status of dissection of the lymph nodes and postoperative complications, and analyzed the significance of EPLND. Results: The patients were aged(69.3±6.6) years old, with the preoperative PSA level of 8.43-434 μg/L, Gleason score(GS) 6 in 1, GS 7 in 9, and GS ≥8 in 19 cases. The operation time averaged(97.2±15.7) min, with the mean blood loss of(30.5±11.2) ml, and 3-42(median = 13) lymph nodes dissected, less than 10 in 10 cases, 11-19 in 12, and more than 20 in 7. Positive pelvic lymph nodes(median = 4) were found in 13 cases, with a positive rate of 44.8%. Positive incisal margin was observed in 11 cases(37.9%), lymphovascular invasion(LVI) in 4(13.8%), and perineural invasion(PNI) in another 4(13.8%). Lymph node metastasis was significantly correlated with positive incisal margin(P<0.05), but not with LVI, PNI or age(P>0.05). No significant vascular or nerve injuries occurred during the operation. GS 6 was detected in 1, GS 7 in 7, and GS ≥8 in 21 cases postoperatively. Conclusion: Robot-assisted laparoscopic EPLND is an important strategy for the treatment of high-risk PCa, which contributes to accurate pathological staging of the malignancy. However, evidence is lacking for its benefit to the survival of high-risk PCa patients, and more follow-up studies are needed to confirm its treatment effect.

【基金】 国家自然科学基金(81801436)~~
  • 【文献出处】 中华男科学杂志 ,National Journal of Andrology , 编辑部邮箱 ,2024年12期
  • 【分类号】R737.25
  • 【下载频次】22
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