Wyler Stephen F, Sulser Tullio, Seifert Hans-Helge, Ruszat Robin, Forster Thomas H, Gasser Thomas C, Bachmann Alexander
Department of Urology, University Hospital Basel, Basel, Switzerland.
Urology. 2006 Oct;68(4):883-7. doi: 10.1016/j.urology.2006.04.037.
Recently, some controversy has arisen as to whether pelvic lymphadenectomy is still necessary for patients with prostate cancer who are undergoing radical prostatectomy. We prospectively evaluated the results and morbidity of laparoscopic extended pelvic lymph node dissection in patients with high-risk prostate cancer defined as a serum prostate-specific antigen (PSA) level greater than 10 ng/mL or preoperative biopsy Gleason score of 7 or more.
In 123 consecutive patients with clinically organ-confined high-risk prostate cancer, laparoscopic extended pelvic lymphadenectomy was performed before laparoscopic radical prostatectomy. The boundaries of the pelvic lymph node dissection were the bifurcation of the common iliac artery superiorly, the node of Cloquet inferiorly, the external iliac vein laterally, and the bladder wall medially. Preparation was done with bipolar forceps and scissors, with meticulous coagulation of all lymphatic tissue. The mean PSA level was 14.8 ng/mL (range 1.5 to 43.4). The mean number of lymph nodes removed was 21 (range 9 to 55). A total of 21 patients (17%) had lymph node metastases. The overall complication rate was 4%.
Laparoscopic extended pelvic lymph node dissection is safe and effective. The results and morbidity are equivalent to those of open surgery, with the advantage of a minimally invasive operative technique.
最近，对于接受根治性前列腺切除术的前列腺癌患者是否仍需进行盆腔淋巴结清扫术出现了一些争议。我们前瞻性评估了腹腔镜扩大盆腔淋巴结清扫术在高危前列腺癌患者中的结果及发病率，高危前列腺癌定义为血清前列腺特异性抗原（PSA）水平大于10 ng/mL或术前活检Gleason评分7分及以上。
在123例临床诊断为器官局限性高危前列腺癌的连续患者中，在腹腔镜根治性前列腺切除术之前进行了腹腔镜扩大盆腔淋巴结清扫术。盆腔淋巴结清扫的边界为上方的髂总动脉分叉处、下方的闭孔淋巴结、外侧的髂外静脉以及内侧的膀胱壁。使用双极电镊和剪刀进行操作，对所有淋巴组织进行细致的凝血处理。平均PSA水平为14.8 ng/mL（范围1.5至43.4）。平均切除淋巴结数量为21个（范围9至55个）。共有21例患者（17%）发生淋巴结转移。总体并发症发生率为4%。
腹腔镜扩大盆腔淋巴结清扫术安全有效。其结果和发病率与开放手术相当，具有微创操作技术的优势。
