Yafi Faysal A, Kassouf Wassim
Department of Surgery (Urology), McGill University, Montréal, QC.
Can Urol Assoc J. 2009 Dec;3(6 Suppl 4):S206-10. doi: 10.5489/cuaj.1197.
Radical cystectomy with lymph node dissection remains the standard of care in the treatment of muscle-invasive and refractory non-invasive bladder cancer. Over the past decade, the extent of lymphadenectomy has varied to include dissection up to the common iliac vessels and aortic bifurcation proximally (may also extend up to the level of the inferior mesenteric artery), the genitofemoral nerve laterally, the circumflex iliac vein and lymph node of Cloquet distally, and the hypogastric vessels posteriorly (obturator fossa, presciatic nodes bilaterally and the presacral lymph nodes over the sacral promontory). Evidence supports the role of lymphadenectomy as both a therapeutic and prognostic variable in patients with invasive bladder cancer. We review the literature regarding the role and extent of lymphadenectomy, as well as its impact on patient outcomes.
根治性膀胱切除术加淋巴结清扫术仍然是治疗肌层浸润性和难治性非肌层浸润性膀胱癌的标准治疗方法。在过去十年中，淋巴结清扫的范围有所不同，包括向上至髂总血管和近端主动脉分叉处（也可能延伸至肠系膜下动脉水平）、向外至生殖股神经、向下至旋髂静脉和闭孔淋巴结以及向后至下腹血管（闭孔窝、双侧坐骨前淋巴结和骶岬上方的骶前淋巴结）。有证据支持淋巴结清扫术在浸润性膀胱癌患者中作为治疗和预后变量的作用。我们回顾了关于淋巴结清扫术的作用、范围及其对患者预后影响的文献。
