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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,以制定更为合理的手术方案。方法:回顾性分析122例多发性肌层浸润性膀胱癌并行根治性膀胱切除患者的临床资料:男88例,女34例,平均年龄61岁。依据大体及病理标本按肿瘤发生部位将患者分为膀胱底部组、膀胱颈口受侵组、膀胱侧壁组和膀胱顶后壁组;盆腔淋巴结清扫区域分为闭孔、髂内、髂外、髂总及骶前共五组。统计分析不同部位肿瘤在各组淋巴结转移的阳性率。结果:膀胱底部组:淋巴结转移率由高到低依次为闭孔、髂外、髂总、髂内、骶前,髂总阳性率高于其他三组(P=0.001);膀胱颈口受侵组: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=0.004);膀胱侧壁组与膀胱顶后壁组: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他各组,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;多发性肌层浸润性膀胱癌中,不同发生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。
Objective: To investigate the metastasis and distribution of tumor sites and pelvic lymph nodes in multiple myasthenia gravis bladder cancer in order to make a more reasonable surgical plan. Methods: A retrospective analysis of 122 cases of multiple myasthenia gravis bladder cancer patients with radical cystectomy clinical data: 88 males and 34 females, mean age 61 years. According to the gross and pathological specimens, the patients were divided into the bottom of the bladder group, the invasion group of the bladder neck, the side wall group of the bladder and the posterior wall group of the bladder; the dissection area of the pelvic lymph node was divided into obturator hole, Common iliac and presacral total of five groups. Statistical analysis of different parts of the tumor in each group of lymph node metastasis positive rate. Results: In the bottom of the bladder group, the rates of lymph node metastasis from high to low were closed-hole, and the positive rates of total iliac, common iliac, internal iliac, presacral and iliac were higher than those in the other three groups (P = 0.001) Group: The rates of lymph node metastasis were closed-cell, external iliac, internal iliac, common iliac, presacral and presacral. The positive rate of lymph node metastasis was higher than that of the other three groups (P = 0.004) The rates of total positive lymph nodes were obtuse (16.8%), extra-iliac (12.7%), intra-iliac (11.3%), Iliac total (4.1%) and presacral (2.5%). The difference between the two groups was statistically significant (P <0.01). CONCLUSION: The positive rate of lymph node in obturator group is higher than that in other groups, and should be taken as a routine cleaning area. The common iliac lymph node metastasis is likely to occur in the bottom of the bladder. The positive rate of presacral lymph nodes is increased after the neck is invaded. Myocardial invasive bladder cancer in different parts of the tumor has its main metastatic area, surgery should pay attention to the regional lymph node dissection.