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目的:探讨腹腔镜根治性膀胱切除术中整块盆腔淋巴结清扫的手术方法和临床价值。方法:回顾性分析2013年2月~2015年2月行腹腔镜下根治性膀胱切除和改良后的整块盆腔淋巴结清扫术40例膀胱癌患者的临床病理资料。40例均为男性,年龄31~80岁,平均60.5岁。T1期2例,T2期19例,T3期13例,T4期6例。结果:所有患者都顺利实施了腹腔镜下手术,无中转开放病例。手术时间140~240min,平均185min。术中出血30~600ml,平均183ml,无输血病例。清扫淋巴结8~22枚,平均13.5枚,淋巴结阳性率为20.0%。术后出现淋巴瘘1例,2周后好转,无其他严重并发症发生。结论:腹腔镜下根治性膀胱切除术联合改进后的整块淋巴结清扫术,可有效避免血管损伤,出血少,保证盆腔淋巴结清扫的彻底性。
Objective: To investigate the surgical method and clinical value of pelvic lymphadenectomy in laparoscopic radical cystectomy. Methods: The clinical and pathological data of 40 patients with bladder cancer underwent laparoscopic radical cystectomy and modified pelvic lymphadenectomy from February 2013 to February 2015 were retrospectively analyzed. 40 cases were men, aged 31 to 80 years, mean 60.5 years. 2 in T1, 19 in T2, 13 in T3 and 6 in T4. Results: All patients underwent laparoscopic surgery successfully without any transfer of open cases. Surgery time 140 ~ 240min, an average of 185min. Intraoperative bleeding 30 ~ 600ml, an average of 183ml, no blood transfusion cases. Lymph node dissection 8 to 22, an average of 13.5, the positive rate of lymph nodes was 20.0%. One case of lymphatic fistula occurred after operation, which improved after two weeks and no other serious complications occurred. Conclusions: Laparoscopic radical cystectomy combined with improved whole lymph node dissection can effectively prevent vascular injury, less bleeding, and ensure the thoroughness of pelvic lymph node dissection.