目的 回顾性分析210例行腹腔镜下扩大淋巴结清扫的根治性膀胱切除术中位数48个月并发症及控瘤效果,证实该技术的安全性和可行性.方法 收集并分析2003年1月～2010年3月210例因膀胱尿路上皮癌行腹腔镜下扩大淋巴结清扫的根治性膀胱切除术患者的并发症及肿瘤控制情况,术中及术后提示淋巴结阳性或T3a期的患者给予辅助化疗.结果 平均手术时间为105min,平均出血量为220ml,围手术前输血率为20.5％,术中平均清扫淋巴结17.6个,淋巴结阳性病例数为42例(20％).围手术期轻度及重度并发症分别为19.0％及5.3％,5年总生存率、肿瘤特异性生存率、未复发生存率及未转移生存率分别为73.8％,83.3％,81.8％及90.5％.结论 腹腔镜下扩大淋巴结清扫的根治性膀胱切除术治疗膀胱尿路上皮癌安全可行,具有满意的控瘤效果.%Objective To investigate the complications and oncologic outcomes of 210 cases of bladder urothelial carcinoma (BUC) treated with laparoscopic radical cystectomy (LRC) with extended pelvic lymph node dissection (EPLND) and assess the feasibility and safety of this surgical technique. Methods From January, 2003 to March 2010, 210 patients with BUC underwent LRC with EPLND. The cases with positive lymph nodes or T3a disease received adjuvant chemotherapy after the operation. The complications and oncologic results were recorded and analyzed. Results The mean operative time was 105 min in these cases with a mean blood loss of 220 ml and a rate of perioperative blood transfusion of 20.5%. The mean number of harvested lymph nodes was 17.6, and 42 (20%) cases were found to have positive lymph nodes. Minor and major perioperative complications occurred in 19% and 5.3% of the cases, respectively. The 5-year estimated overall survival, cancer-specific survival, recurrence-free survival and metastasis-free survival rates were 73.8%, 83.3%, 81.8% and 90.5%, respectively. Conclusions LRC with EPLND is a safe and feasible technique for management of BUC and can produce satisfactory oncologic results.
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