中华泌尿外科杂志
中華泌尿外科雜誌
중화비뇨외과잡지
CHINESE JOURNAL OF UROLOGY
2015年
8期
595-599
,共5页
刘茁%孟一森%虞巍%金杰%张骞
劉茁%孟一森%虞巍%金傑%張鶱
류촬%맹일삼%우외%금걸%장건
前列腺肿瘤%根治性前列腺切除术%腹膜外途径%腹腔镜
前列腺腫瘤%根治性前列腺切除術%腹膜外途徑%腹腔鏡
전렬선종류%근치성전렬선절제술%복막외도경%복강경
Prostatic neoplasms%Radical prostatectomy%Extraperitoneal approach%Laparoscopes
目的 比较同一外科医生行三孔法经腹膜外途径腹腔镜下根治性前列腺切除术(extraperitoneal laparoscopic radical prostatectomy,ELRP)与传统四孔法ELRP的近期临床疗效,分析三孔法ELRP治疗局限性前列腺癌的安全性和有效性.方法 回顾性分析2010年1 1月至2014年10月同一外科医生收治的200例行ELRP的前列腺癌患者的临床资料,分为三孔法组(95例)和四孔法组(105例).三孔法ELRP是在传统四孔法Cleveland术式的基础上,省略右侧髂前上棘内侧穿刺孔简化而成.患者年龄(66.8±15.5)岁,总前列腺特异性抗原(tPSA)(15.3±12.4) μg/L.两组患者的年龄、体质指数、术前tPSA、临床分期、术前是否行新辅助内分泌治疗、经尿道前列腺切除手术史、糖尿病史等指标比较差异均无统计学意义(P＞0.05).三孔法组经直肠B超前列腺体积为(35.6±16.7)ml,四孔法组为(42.2±24.7)ml,组间比较差异有统计学意义(P＜0.05).比较两组的手术时间、术中出血量、术后住院天数、术后腹腔引流管留置时间、术后Gleason评分、病理分级、手术切缘情况、术后生化复发率、术后尿失禁发生率等.结果 三孔法组和四孔法组手术时间分别为(81.0±18.6)、(103.6±34.6)min,术中出血量分别为(102.6±75.8)、(217.5±182.9)ml,切缘阳性率分别为13.7％ (13/95)和27.6％ (29/105),术后Gleason评分＞7分者分别为9、29例,组间比较差异均有统计学意义(P＜0.05).两组术后住院天数、术后腹腔引流管留置时间、病理分期比较差异均无统计学意义(P＞0.05).三孔法组83例(87.4％)获随访,随访时间5 ～19个月,中位时间11个月;四孔法组92例(87.6％)获随访,随访时间17 ～52个月,中位时间27个月.两组术后生化复发率及术后3、6、12个月尿失禁发生率比较差异均无统计学意义(P＞0.05).结论 与四孔法相比,三孔法ELRP手术时间、术中出血量、病理切缘等效果相对较好,近期肿瘤控制和术后控尿功能恢复情况相似.对于有丰富腹腔镜手术经验的医师,可行三孔法ELRP治疗局限性前列腺癌.
目的 比較同一外科醫生行三孔法經腹膜外途徑腹腔鏡下根治性前列腺切除術(extraperitoneal laparoscopic radical prostatectomy,ELRP)與傳統四孔法ELRP的近期臨床療效,分析三孔法ELRP治療跼限性前列腺癌的安全性和有效性.方法 迴顧性分析2010年1 1月至2014年10月同一外科醫生收治的200例行ELRP的前列腺癌患者的臨床資料,分為三孔法組(95例)和四孔法組(105例).三孔法ELRP是在傳統四孔法Cleveland術式的基礎上,省略右側髂前上棘內側穿刺孔簡化而成.患者年齡(66.8±15.5)歲,總前列腺特異性抗原(tPSA)(15.3±12.4) μg/L.兩組患者的年齡、體質指數、術前tPSA、臨床分期、術前是否行新輔助內分泌治療、經尿道前列腺切除手術史、糖尿病史等指標比較差異均無統計學意義(P＞0.05).三孔法組經直腸B超前列腺體積為(35.6±16.7)ml,四孔法組為(42.2±24.7)ml,組間比較差異有統計學意義(P＜0.05).比較兩組的手術時間、術中齣血量、術後住院天數、術後腹腔引流管留置時間、術後Gleason評分、病理分級、手術切緣情況、術後生化複髮率、術後尿失禁髮生率等.結果 三孔法組和四孔法組手術時間分彆為(81.0±18.6)、(103.6±34.6)min,術中齣血量分彆為(102.6±75.8)、(217.5±182.9)ml,切緣暘性率分彆為13.7％ (13/95)和27.6％ (29/105),術後Gleason評分＞7分者分彆為9、29例,組間比較差異均有統計學意義(P＜0.05).兩組術後住院天數、術後腹腔引流管留置時間、病理分期比較差異均無統計學意義(P＞0.05).三孔法組83例(87.4％)穫隨訪,隨訪時間5 ～19箇月,中位時間11箇月;四孔法組92例(87.6％)穫隨訪,隨訪時間17 ～52箇月,中位時間27箇月.兩組術後生化複髮率及術後3、6、12箇月尿失禁髮生率比較差異均無統計學意義(P＞0.05).結論 與四孔法相比,三孔法ELRP手術時間、術中齣血量、病理切緣等效果相對較好,近期腫瘤控製和術後控尿功能恢複情況相似.對于有豐富腹腔鏡手術經驗的醫師,可行三孔法ELRP治療跼限性前列腺癌.
목적 비교동일외과의생행삼공법경복막외도경복강경하근치성전렬선절제술(extraperitoneal laparoscopic radical prostatectomy,ELRP)여전통사공법ELRP적근기림상료효,분석삼공법ELRP치료국한성전렬선암적안전성화유효성.방법 회고성분석2010년1 1월지2014년10월동일외과의생수치적200례행ELRP적전렬선암환자적림상자료,분위삼공법조(95례)화사공법조(105례).삼공법ELRP시재전통사공법Cleveland술식적기출상,성략우측가전상극내측천자공간화이성.환자년령(66.8±15.5)세,총전렬선특이성항원(tPSA)(15.3±12.4) μg/L.량조환자적년령、체질지수、술전tPSA、림상분기、술전시부행신보조내분비치료、경뇨도전렬선절제수술사、당뇨병사등지표비교차이균무통계학의의(P＞0.05).삼공법조경직장B초전렬선체적위(35.6±16.7)ml,사공법조위(42.2±24.7)ml,조간비교차이유통계학의의(P＜0.05).비교량조적수술시간、술중출혈량、술후주원천수、술후복강인류관류치시간、술후Gleason평분、병리분급、수술절연정황、술후생화복발솔、술후뇨실금발생솔등.결과 삼공법조화사공법조수술시간분별위(81.0±18.6)、(103.6±34.6)min,술중출혈량분별위(102.6±75.8)、(217.5±182.9)ml,절연양성솔분별위13.7％ (13/95)화27.6％ (29/105),술후Gleason평분＞7분자분별위9、29례,조간비교차이균유통계학의의(P＜0.05).량조술후주원천수、술후복강인류관류치시간、병리분기비교차이균무통계학의의(P＞0.05).삼공법조83례(87.4％)획수방,수방시간5 ～19개월,중위시간11개월;사공법조92례(87.6％)획수방,수방시간17 ～52개월,중위시간27개월.량조술후생화복발솔급술후3、6、12개월뇨실금발생솔비교차이균무통계학의의(P＞0.05).결론 여사공법상비,삼공법ELRP수술시간、술중출혈량、병리절연등효과상대교호,근기종류공제화술후공뇨공능회복정황상사.대우유봉부복강경수술경험적의사,가행삼공법ELRP치료국한성전렬선암.
Objective To compare the perioperative outcomes and short-term efficacy of three-port extraperitoneal laparoscopic radical prostatectomy (ELRP) and four-port ELRP.Methods Two hundred patients who had undergone ELRP for prostate cancer by a single surgeon from November 2010 to October 2014 were retrospectively analyzed.Among them,95 cases underwent three-port ELRP and 105 cases underwent four-port ELRP.On the basis of traditional four-port ELRP,three-port ELRP was characterized by the omission of the trocar on the inner side of right anterior superior iliac spine.The mean age was 66.8 ± 15.5 years,and mean total prostate specific antigen (tPSA) was 15.3 ± 12.4 μg/L.There were no significant differences including age,body mass index,tPSA,clinical stages,acceptance of neoadjuvant hormone therapy,history of transurethral resection of the prostate,history of diabetes mellitus between the 2 groups (P ＞ 0.05).Patients in three-port ELRP group had significantly smaller prostate volume than fourport group (35.6 ± 16.7 ml versus 42.2 ± 24.7 ml,P ＜ 0.05).The clinical factors as operative time,estimated blood loss,hospital stay,drainage tube keeping days,pathological Gleason scores,pathological stages,positive surgical margin rates,biochemical recurrence rates and urinary incontinence rates were compared between the 2 groups.Results The three-port group had significantly shorter operative time than the four-port group (81.0 ± 18.6 min versus 103.6 ±34.6 min),less estimated blood loss (102.6 ±75.8 ml versus 217.5 ± 182.9 ml),less positive surgical margin rates (13.7％ versus 27.6％).There were 9 patients having Gleason scores more than 7 in the three-port ELRP group and 29 patients in four-port ELRP group (P ＜ 0.05).There were no significant differences of hospital stay,drainage tube keeping days,pathological stages between the 2 groups (P ＞ 0.05).Eighty-three cases in the three-port ELRP group (87.4％) were followed up for 5-19 months with the median time of 11 months.Ninety-two cases in fourport ELRP group (87.6％) were followed up for 17-52 months and the median time was 27 months.There were no significant differences of biochemical recurrence rates and urinary incontinence rates between the 2 groups(P ＞ 0.05).Conclusions Compared to four-port ELRP,three-port ELRP can provide shorter operative time,less blood loss,better negative surgical margin rates,similar oncological control and recovery of postoperative continence.In experienced hands,three-port ELRP could be a feasible and effective option for localized prostate cancer.
