不同途径经腹膜外腹腔镜下根治性前列腺切除术的临床疗效分析

吴绍山; 谈宜傲; 陶陶; 肖峻; 周林玉

doi:10.13898/j.cnki.issn.1000-2200.2019.09.031

不同途径经腹膜外腹腔镜下根治性前列腺切除术的临床疗效分析

Clinical analysis of extraperitoneal laparoscopic radical prostatectomy by different surgical approaches

摘要

摘要:
目的探讨不同途径经腹膜外腹腔镜下根治性前列腺切除术（ELRP）治疗局限性前列腺癌的临床疗效。
方法对87例经ELRP治疗的局限性前列腺癌病人临床资料进行回顾性分析，其中三孔法ELRP组28例，四孔法ELRP组59例。所有病人术前均行前列腺穿刺活检或前列腺电切术后病理证实为前列腺癌，且排除外周组织器官浸润及盆腔淋巴结转移。对2组病人年龄、总前列腺特异性抗原（tPSA）、前列腺体积、临床分期、高血压、手术时间、术中出血量、术后Gleason评分、手术切缘阳性、术后生化复发率和术后尿管留置时间等分析比较。
结果所有病人均顺利完成手术，无一例中转开放手术。三孔法ELRP组手术时间、术中出血量、前列腺体积分别为（90.56±17.87）min、（121.45±45.76）mL、（36.75±12.26）mL，均少于四孔法ELRP组的（118.66±22.45）min、（189.87±75.43）mL、（67.47±22.65）mL（P < 0.05）；切缘阳性数分别为2例和4例、术后加用内分泌治疗，2组差异无统计学意义（P>0.05）。此外，2组病人在年龄、tPSA、临床分期、术前是否合并高血压、术后Gleason评分、术后尿管留置时间及术后复发方面差异均无统计学意义（P>0.05）。术后随访3~17月，生化复发6例，予内分泌治疗后控制满意。
结论相比于四孔法ELRP，三孔法ELRP不仅尚未增加并发症，而且更加微创，对于体积较小局限性前列腺癌值得临床推广应用。

Abstract:
ObjectiveTo investigate the clinical analysis of extraperitoneal laparoscopic radical prostatectomy on local prostate cancer by different surgical approaches.
MethodsThe clinical data of 87 patients with local prostate cancer undergoing extraperitoneal laparoscopic radical prostatectomy were retrospectively analyzed.Among them, 28 cases underwent three-port ELRP and 59 cases underwent four-port ELRP.The clinical factors as ages, tPSA, prostate volume, clinical stage, hypertension, operative time, estimated blood loss, pathological scores, positive surgical margin rates, biochemical recurrence and drainage tube keeping days.
ResultsAll the patients underwent successful surgery without turn to open surgery.During the three-port group and four-port group, operative time were (90.56±17.87) min and(118.66±22.45) min, the estimated blood loss were(121.45±45.76)mL and (189.87±75.43) mL, prostate volume were (36.75±12.26) mL and (67.47±22.65) mL respectively, with significant statistical difference(P < 0.05).Positive surgical margin were 2 cases and 4 cases, of which underwent the endocrine therapy, with no statistical difference(P>0.05).These was no statistical difference in the other factors(P>0.05).Follow-up 3 to 17 months after surgery, biochemical recurrence in 6 cases, to endocrine control satisfaction.
ConclusionsCompared with the four-port ELRP, the three-port ELRP not only has not increased complicaiton, but also is more minimally invasive.It is worthy of clinical application for small and localized prostate cancer.

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