多发性肌层浸润性膀胱癌中肿瘤发生部位与阳性淋巴结在盆腔内分布状况的研究

发布时间：2018-08-12 19:40

【摘要】：目的探讨多发性肌层浸润性膀胱癌中肿瘤发生部位与盆腔淋巴结转移和分布情况，以为此类肿瘤制定更为合理的淋巴结清扫方案。方法回顾性分析122例多发性膀胱癌并行根治性膀胱切除患者的临床病例，男88例，女34例，平均年龄61岁。术后病理提示均为肌层浸润性膀胱癌。依据大体及病理标本将肿瘤发生部位分为膀胱底部组、颈口组、侧壁组和顶后壁组；盆腔淋巴结清扫区域分为闭孔组、髂内组、髂外组、髂总组及骶前组。统计分析膀胱内不同发生部位的肿瘤其各组淋巴结转移的阳性率。结果膀胱底部组共34例，淋巴结转移率由高到低依次为闭孔、髂外、髂总、髂内、骶前，髂总阳性率高于余下三组（P=0.013）；颈口组共29例，淋巴结转移率依次为闭孔、髂外、髂内、髂总、骶前，骶前阳性率高于其他三组（P=0.037）；侧壁组与顶后壁组分别为27例与32例，淋巴结转移率依次为闭孔、髂外、髂内、髂总、骶前；总阳性淋巴结检出率由高到低为：闭孔（16.8%）、髂外（12.7%）、髂内（11.3%）、髂总（4.1%）、骶前（2.5%）；组间比较差异有统计学意义（P＜0.01）。结论闭孔组淋巴结阳性率高于其余各组，应作为常规清扫区域；膀胱底部肿瘤易发生髂总淋巴结转移，颈口受侵后骶前淋巴结阳性率增高，，清扫区域应向上扩大；在多发性肌层浸润性膀胱癌中，不同部位肿瘤有其主要转移区域，术中应注意对该区域淋巴结重点清扫。
[Abstract]:Objective To investigate the location of tumor and the distribution of pelvic lymph node metastasis in multiple myometrial invasive bladder cancer (MIBC), so as to make a more reasonable lymph node dissection plan for this kind of tumor.
Methods The clinical data of 122 patients with multiple bladder cancer undergoing radical cystectomy were retrospectively analyzed, including 88 males and 34 females, with an average age of 61 years. The dissection area was divided into obturator group, internal iliac group, external iliac group, common iliac group and presacral group.
Results The total positive rate of lymph node metastasis in the bladder floor group was higher than that in the other three groups (P = 0.013), and that in the neck orifice group was higher than that in the other three groups (P = 0.037). The lymph node metastasis rates were obturator, external iliac, internal iliac, total iliac and presacral in turn; the total positive lymph node detection rates from high to low were obturator (16.8%), external iliac (12.7%), internal iliac (11.3%), total iliac (4.1%) and anterior sacral (2.5%).
Conclusion The positive rate of lymph nodes in obturator group is higher than that in other groups and should be used as a routine clearance area. Attention should be paid to key lymph nodes in this area.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.14

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