摘要
目的:回顾分析329例经腹膜外腹腔镜前列腺癌根治术的手术方法和疗效。方法:2005年3月～2010年3月经腹膜外腹腔镜前列腺癌根治术329例,中位年龄67岁,初始前列腺特异性抗原中位数为17.35μg/L,活检Gleason评分中位数为7。结果:329例手术均成功完成,无中转开放手术。膀胱尿道吻合时间中位数为13min,手术时间中位数为90min,术中失血量中位数为75ml,术后尿管留置时间中位数为6d。整体切缘阳性率为16.7%,与病理分期和Gleason评分具有相关性(P<0.001)。术后1年内,年轻患者的尿控能力恢复较快,而且性功能恢复较好。术后随访时间中位数为27(14～72)个月,89例出现生化复发;多因素分析显示初始PSA值、切缘阳性率、病理分期和Gleason评分是无生化复发生存的独立预后因素。术前新辅助激素治疗对病理Gl-eason评分(P<0.001)和手术切缘阳性率(P=0.027)有显著影响,但对生化复发没有显著影响(P=0.202)。结论:经腹膜外腹腔镜前列腺癌根治术是局限性前列腺癌安全有效的微创外科治疗方法,值得临床推广。
Objective：To evaluate retrospectively the surgery skill and effects of extraperitioneal laparoscopic radical prostatectomy for prostate cancer. Method：Between March 2005 and March 2010, we performed 329 cases of extraperitoneal laparoseopic radical prostatectomy. The median age of patients was 67 years and the median initial prostate specific antigen was 17.35 μg/L. The median biopsy Gleason score was 7. Reasult： All the operations were successful without coversion. The median time for the anastomosis, the median operative time and the medi- an postoperative catheterization time were 13 minutes, 90 minutes and 6 days, respectively. The median estimated blood loss was 75 mI. The overall positive surgical margin rate was 16.7%and correlated with pathological stage and Gleason score, respectively（P〈0. 001）. Younger patients had a quicker recovery of continence and a better postoperative potency in one year postoperatively. The median follow-up time was 27 （range 14-72）months. 89 （28.6 %）patients were diagnosed as biochemical recurrence. The initial PSA value, PSM, pathological stage and Gleason score were identified as independent prognostic factors for biochemical recurrence free survival in multiva riate analysis. Preoperative NHT had significant impacts on pathological Gleason score（P〈 0. 001）and surgical margin（P=0. 027）, but no significant impact on biochemical recurrence（P=0. 202）. Conclusion.. The extraperitioneal laparoscopic radical prostatectomy may be considered as an effective and safe surgical approach for localized prostate cancer, worth to be extended.
出处
《临床泌尿外科杂志》
2012年第7期481-484,共4页
Journal of Clinical Urology
基金
博士后科学基金资助(编号201150M1535)
国家自然科学基金杰出青年学者项目资助(编号30725040)
关键词
前列腺癌
前列腺根治术
腹膜外途径
生化复发
prostate cancer
radical prostatectomy
extraperitoneal approach
biochemical recurrence
