前列腺癌论文腹腔镜局限和标准盆腔淋巴结清扫术在前列.doc

前列腺癌论文：腹腔镜局限和标准盆腔淋巴结清扫术在前列腺癌分期诊断中的应用及意义【中文摘要】评价腹腔镜局限性和标准盆腔淋巴结清扫术在前列腺癌分期诊断中的意义。方法：回顾分析在2007年6月至2011年3月期间,在南昌大学第一附属医院行腹腔镜盆腔淋巴结清扫术治疗35例前列腺癌患者的临床资料。其中21例转移低中风险组(A组)行腹腔镜局限性盆腔淋巴结清扫术,以及14例转移高风险组(B组)行腹腔镜标准盆腔淋巴结清扫术。所有患者术前病理报告诊断为前列腺癌,依据Gleason评分及术前影像学检查等对前列腺癌的转移风险进行评估,指导术中淋巴结清扫的范围以及避免周围器官损伤。术中及术后评价比较两组盆腔淋巴结清扫数目、阳性淋巴结数、平均手术时间、术中出血量、术后肠功能恢复情况、住院总费用及住院天数之间差异。结果：35例患者均手术成功,无中转开放病例,无闭孔神经损伤等并发症,术后病理检查均发现淋巴结。A组与B组活检淋巴结数分别为7.382.39个和17.853.03个(P0.05)；术后胃肠功能恢复时间分别为61.013.9 h和72.08.8 h(P0.05)；术后住院天数分别为16.92.7 d和18.03.9 d(P0.05)；总住院费分别为19599.83260.6元和21448.53669.6元(P0.05)；差异均无显著性意义。结论：准确的淋巴结分期将有助于临床医生判断复发高危患者并及时使用辅助治疗使患者受益。对转移高风险前列腺癌患者行标准淋巴结清扫有助于提高阳性淋巴结的诊断,而对于低中风险前列腺癌仅行局限性清扫已能满足诊断需求。与局限性淋巴清扫术相比,腹腔镜标准淋巴结清扫术也是安全的,其中远期疗效尚待大样本长期随访而定。【英文摘要】:To evaluate the clinical outcome of laparoscopic lymph node dissection in the staging of prostate cancer。Methods:From June 2007 to March 2011,21 cases of prostate cancer (group A) were selected for Laparoscopic limited pelvic lymph node dissection and 14 Patients (group B) were selected for Laparoscopic standard pelvic lymph node dissection. The pre-operation evaluation for prostate cancer was based on Gleason score and preoperative imaging studies, which could guide the scope of intraoperative lymph node dissection and avoid to damage vasculars during operation. The number of pelvic lymph node dissection, positive nodes, operating time, blood loss during operation, recovery of intestinal function postoperation, retention time of rubber drainage tube, the total hospital costs, the hospital stay time and complications during operation or postoperation were evaluated on all patients.Results:All cases have been successfully treated with Pelvic lymph node dissection. There was significant difference in the operating time and the number of positive lymph nodes between two groups. the number of pelvic lymph nodes in the group A and group B was 7.382.39 and 17.853.03 (P0.05); the recovery time of intestinal function postoperation was 61.013.9 hrs and 72.08.8 hrs (P 0.05); the hospital stay time was 16.92.7 d and 18.03.9 d (P 0.05), the hospitalization was RMB 19599.83260.6 and RMB 21448.53669.6 (P0.05).Conclusions:Accurate lymph node staging will help clinicians to accurately determine the recurrence of high-risk patients and timely use of adjuvant therapy in some patients. At present, the pelvic lymph node dissection lymph node metastasis of prostate cancer is still the standard of diagnosis. Group of lymph node metastasis in patients with high risk scores, usually occurs to the multiple pelvic lymph nodes or outside lymph node metastasis (the transfer across the pathway or alternative pathway), the standard lymph node dissection is more suitable.【关键词】前列腺癌 腹腔镜手术 盆腔淋巴结清扫术 阳性淋巴结 前哨淋巴结【英文关键词】Prostate cancer Laparoscopy pelvic lymph node dissection positive lymph nodes sentinel lymph node【目录】腹腔镜局限和标准盆腔淋巴结清扫术在前列腺癌分期诊断中的应用及意义摘要3-4ABSTRACT4-5第1章 前言8-121.1 流行病学和病因81.2 前列腺癌的转移8-91.3 前列腺癌转移风险的评估9-101.4 前列腺癌的腹腔镜手术治疗10-12第2章 资料与方法12-202.1 一般资料122.2 术前评估12-132.2.1 一般及全身情况评估122.2.2 前列腺癌临床分期的评估12-132.2.3 前列腺癌转移风险的评估132.2.4 术前手术方案的选择132.3 手术方法13-142.3.1 腹腔镜局限性盆腔淋巴结清扫术132.3.2 腹腔镜标准盆腔淋巴结清扫术13-142.3.3 腹腔镜标准盆腔淋巴结清扫术B(组)142.4 随访142.5 结果分析和统计学方法14-20第3章 结果20-25第4章 讨论25-294.1 腹腔镜下盆腔淋巴结清扫手术适应证25-2