CAJ | 학술논문

目的：比较经腹腔途径（Transperitoneal laparoscopic radical prostatectomy，T-LRP）与经腹膜外途径腹腔镜下前列腺癌根治术（Extraperitoneal laparoscopic radical prostatectomy，E-LRP）临床疗效。方法回顾分析我院2010年1月至2012年12月收治腹腔镜下前列腺癌根治术130例，其中经腹腔途径腹腔镜下前列腺癌根治术72例；经腹膜外途径58例。比较两种术式患者体重指数（BMI）、术前PSA、术前穿刺Glesson评分、临床TNM分期（c-TNM）、前列腺体积、手术时间、术中出血量、术中输血比例、术后胃肠功能恢复时间、术后留置导尿时间、术后住院天数、围手术期并发症、病理分期（p-TNM）、术后尿控等指标。结果130例手术均获得成功，中转开放手术2例，其中T-LRP组1例，E-LRP组1例；T-LRP组平均手术时间长于E-LRP组，（120.6±92.6） min 对（110.8±100.5）min，（P ＜0.001）；T-LRP组术中平均出血量多于E-LRP组，（110.9±50.6）ml对（95.8±123.5）ml，（P＜0.05）；T-LRP组术后平均留置尿管时间长于E-LRP组，（13.42±4.64）d对（12.33±4.82）d，（P＜0.05）；T-LRP组术后平均住院时间长于E-LRP组，（14.54±5.25）d对（11.63±5.82）d，（P＜0.05）。随访时间为6~42月，中位时间32月；T-LRP组与E-LRP组在拔尿管时、术后半年，尿控满意率分别为48.6%（35/72）对34.5%（20/58）、63.8%（46/72）对89.6%（52/58），有统计学意义（P值分别为：P＜0.05、P＜0.001），但其1年后尿控率无明显差异（P＞0.05）。结论 E-LRP相对T-LRP具有相同的远期控瘤效果和尿控效果，但E-LRP术后的早期尿控效果优于T-LRP。经腹膜外途径路入较经腹腔路入具有术中出血少、手术时间短，术后腹腔并发症少，术后恢复快等优点。
목적：비교경복강도경（Transperitoneal laparoscopic radical prostatectomy，T-LRP）여경복막외도경복강경하전렬선암근치술（Extraperitoneal laparoscopic radical prostatectomy，E-LRP）림상료효。방법회고분석아원2010년1월지2012년12월수치복강경하전렬선암근치술130례，기중경복강도경복강경하전렬선암근치술72례；경복막외도경58례。비교량충술식환자체중지수（BMI）、술전PSA、술전천자Glesson평분、림상TNM분기（c-TNM）、전렬선체적、수술시간、술중출혈량、술중수혈비례、술후위장공능회복시간、술후류치도뇨시간、술후주원천수、위수술기병발증、병리분기（p-TNM）、술후뇨공등지표。결과130례수술균획득성공，중전개방수술2례，기중T-LRP조1례，E-LRP조1례；T-LRP조평균수술시간장우E-LRP조，（120.6±92.6） min 대（110.8±100.5）min，（P ＜0.001）；T-LRP조술중평균출혈량다우E-LRP조，（110.9±50.6）ml대（95.8±123.5）ml，（P＜0.05）；T-LRP조술후평균류치뇨관시간장우E-LRP조，（13.42±4.64）d대（12.33±4.82）d，（P＜0.05）；T-LRP조술후평균주원시간장우E-LRP조，（14.54±5.25）d대（11.63±5.82）d，（P＜0.05）。수방시간위6~42월，중위시간32월；T-LRP조여E-LRP조재발뇨관시、술후반년，뇨공만의솔분별위48.6%（35/72）대34.5%（20/58）、63.8%（46/72）대89.6%（52/58），유통계학의의（P치분별위：P＜0.05、P＜0.001），단기1년후뇨공솔무명현차이（P＞0.05）。결론 E-LRP상대T-LRP구유상동적원기공류효과화뇨공효과，단E-LRP술후적조기뇨공효과우우T-LRP。경복막외도경로입교경복강로입구유술중출혈소、수술시간단，술후복강병발증소，술후회복쾌등우점。
Objective To evaluate the efficiency of transperitoneal laparoscopic radical prostatectomy (T-LRP) and extraperitoneal laparoscopic radical prostatectomy (E-LRP). Methods Clinical data 130 patients with prostate cancer who underwent laparoscopic radical prostatectomy from January 2010 and December 2012 were retrospectively analyzed. Of these patients, 72 were done by transperitoneal style and 58 by extraperitoneal style. The BMI, preoperative PSA, preoperative Gleason grade, c-TNM, operating time, bleeding volume during operation, blood transfusions rate, postoperative pain, the recovery time of intestinal function, the duration of catheterization, hospitalization stay after operation, complication, p-TNM, continence rate were comparatively analyzed. Results Operations of two groups were all successfully performed. One case of T-LRP group and 1 case of E-LRP were converted to open surgery. The mean operating time of T-LRP group was longer than that of the E-LRP group, (120.6±92.6)min vs.(110.8±100.5)min ,and there was statistical difference between these two groups(P<0.001). The mean bleeding volume during operation of T-LRP group was more than that of the E-LRP group , (110.9±50.6)ml vs.(95.8±123.5)ml, there was a statistical difference between these two groups(P<0.05). The duration of catheterization of T-LRP group was longer than that of the E-LRP group, (13.42±4.64)days vs.(12.33±4.82)days, there was a statistical difference between these two groups (P<0.05). The hospitalization of T-LRP group was longer than that of the E-LRP group, (14.54±5.25)days vs.(11.63±5.82)days, there was a statistical difference between these two groups(P<0.05). 120 patients were followed up for 6~42months, and the median time was 32 months. In the T-LRP group and E-LRP group, the continence rate at the time of pulling the urine tube was 48.6%(35/72)vs34.5%(20/58); the six-month continence rate was 63.8%(46/72)vs. 89.6%(52/58), there was statistical difference between these two groups(P<0.05, P<0.001,separately).But there was no statistical difference between these two groups in the one-year continence rate (P=0.324). Conclusion E-LRP and T-LRP have the equivalent oncological and functional outcomes. ELRP is superior to T-LRP with respect to faster recovery of continence. E-LRP shows some advantage over T-LRP including the small of intraoperative trauma ,short operation time, fewer abdominal complications, quicker recovery, etc.