CAJ | 학술논문

目的：探讨腹腔镜前列腺癌根治术在高危前列腺癌治疗中的价值。方法回顾性分析2012年3月～2014年11月本院腹腔镜前列腺癌根治术治疗26例高危前列腺癌的临床资料。患者平均年龄65．2岁，术前检查单独PSA≥20ng／mL者9例；兼具PSA≥20ng／mL并Gleason评分≥8分者17例；术前诊断T3 b和T4期各1例。3例患者因前列腺体积过大术前分别行3～6个月新辅助内分泌治疗。手术方式均采用经腹膜外路径腹腔镜前列腺癌根治术，同时行盆腔淋巴结清扫。结果26例手术均获成功，平均手术时间152min，平均出血量85mL，无输血病例。所有患者均于术后两周拔除导尿管，8例拔管后尿失禁，经盆底训练后于1周至3个月恢复控尿。术后病理T2a～T2b，Gleason评分≤7分者10例；T2c～T4，Gleason评分≥8分者16例。术中清扫淋巴结数目平均5．5个，淋巴结阳性3例；切缘阳性4例，术后控尿恢复后予局部放射治疗。19例获访3～30个月，所有患者均控尿良好，PSA≤0．2ng／mL。结论对高危前列腺癌患者采用以根治性前列腺癌切除术为核心的综合治疗策略安全有效，可使患者获益。
목적：탐토복강경전렬선암근치술재고위전렬선암치료중적개치。방법회고성분석2012년3월～2014년11월본원복강경전렬선암근치술치료26례고위전렬선암적림상자료。환자평균년령65．2세，술전검사단독PSA≥20ng／mL자9례；겸구PSA≥20ng／mL병Gleason평분≥8분자17례；술전진단T3 b화T4기각1례。3례환자인전렬선체적과대술전분별행3～6개월신보조내분비치료。수술방식균채용경복막외로경복강경전렬선암근치술，동시행분강림파결청소。결과26례수술균획성공，평균수술시간152min，평균출혈량85mL，무수혈병례。소유환자균우술후량주발제도뇨관，8례발관후뇨실금，경분저훈련후우1주지3개월회복공뇨。술후병리T2a～T2b，Gleason평분≤7분자10례；T2c～T4，Gleason평분≥8분자16례。술중청소림파결수목평균5．5개，림파결양성3례；절연양성4례，술후공뇨회복후여국부방사치료。19례획방3～30개월，소유환자균공뇨량호，PSA≤0．2ng／mL。결론대고위전렬선암환자채용이근치성전렬선암절제술위핵심적종합치료책략안전유효，가사환자획익。
Objectives To evaluate the clinical efficiency of laparoscopic radical prostatectomy for high risk prostate cancer.Methods The clinical data of 26 patients with high risk prostate cancer who underwent laparoscopic radical prostatectomy from March 3, 2014 to November 2015 were analyzed retrospectively, with the average age of 65. 2 .In preoperative examination, there were 9 cases with PSA≥20ng/ml only, and 17 cases with PSA≥20ng/ml and Gleason score≥8,meanwhile there is one case in both the T3b phase and T4 phase.Three cases were treated with neo-adjuvant hormone therapy for 3 ~6 months.All patients underwent extraperitoneal laparoscopic radical prostatectomy and pelvic lymph node dissection.Results All operation were successful.The mean operation time was 152min, mean blood loss was 85ml, mean catheterization time were two weeks.Postoperative temporary urinary incontinence oc-curred in 8 cases, and all recoved within 1 week to 3 months.After the operation, there were 7 cases in T2a~T2b phase and Gleason score≤7, 16 cases in T2c~T4 phase and Gleason score≥8.The mean number of lymph node dis-sected was 5.5.Three cases had lymph positive ,four cases hadpositive surgical margins and all underwent radiation therapy after continence was regained.19 cases were followed up for 3~30 months, no true incontinence was observed, and PSA≤0.2ng/ml in all patients.Conclusions As the core of comprehensive treatment strategies, radical pros-tatectomy is safe and effective for high risk prostate cancer .