摘要
目的︰探讨前列腺突人膀胱与腹腔镜根治性前列腺切除术后切缘阳性及基底部切缘阳性的相关性。方法﹐回顾性分析2015年8月至2018年4月北京大学第三医院行腹腔镜根治性前列腺切除术110例患者的临床资料。患者年龄(70.4±7.8)岁,其中6l例≥70岁,49例<70岁;穿刺前中位PSA 12.23(0.78~110)ng/ml,其中PSA<10,10~20、>20 ng/ml者分别为44,36,30例;穿刺Cleason评分6.7,≥8分者分别为27,35,48例;临床分期T,期73例,T,期37例;中位前列腺体积38.16(11.83~163.36)ml,其中前列腺体积<30,30~50、>50 ml者分别为31,47,32例。前列腺突入膀胱长度(IPPL)定义为MRI检查矢状位测量突入膀胱前列腺组织顶点至膀胱基底部的垂直距离;IPPL术前中位值3(0~27)mm,其中72例<5 mm,38例≥5 mm。所有患者均行腹膜外腹腔镜根治性前列腺切除术,记录患者切缘情况及阳性切缘位置等。采用x^2检验进行单因素分析,采用logistic多因素回归分析影响切缘阳性和基底部切缘阳性的独立危险因素。结果术后切缘阳性42例(38.1%),其中基底部切缘阳性25例(22.7%)。x^2检验结果显示临床分期(P<0.001),IPPL(P=0.038)与术后切缘阳性有关,将临床分期、穿刺Gleason评分,IPPL纳入多因素logistic回归分析,结果显示临床分期T,期(P<0.001)是切缘阳性的独立危险因素。x^2检验结果显示临床分期(P<0.001),IPPL(P=0.00I)与术后基底部切缘阳性有关;将临床分期、穿刺Gleason评分、IPPL.纳入多因素logistic回归分析,结果显示临床分期T,期(P<0.001)和IPPL≥5 mm(P=0.009)是基底部切缘阳性的独立危险因素。结论﹑对于接受腹腔镜根治性前列腺切除术的前列腺癌患者,临床分期为T,期是切缘阳性的独立危险因素,临床分期为T,期和IPPL≥5 mm是术后基底部切缘阳性的独立危险因素。
Objective To identify the relationship between positive surgical margin afterlaparoscopic radical prostatectomy and intravesical prostatic protrusion length on preoperative magneticresonance imaging.Methods We retrospectively analyzed 110 patients with pathologic confirmed prostatecarcinoma who underwent laparoscopic radical prostatectomy in our hospital.For all 110 patients,theaverage age was(70.4±7.8)years old,median pre-biopsy PSA was 12.23 ng/ml(range 0.78-110 ng/ml).There were 27 cases,35 cases and 48 cases for biopsy Gleason score 6,7 and≥8.There were 73patients with clinical stage T,and T,,37 patients with clinical stage T,.The median prostatic volume was38.16ml(range 11.83-163.36ml).MRI examination was performed in l week before the biopsy.Intravesical prostatic protrusion length(IPPL.)was measured on MRl as the vertical distance from the tip ofthe protruding prostate to the base of the urinary bladder.All patients who underwent MRl preoperativelymedian IPPL was 3 mm(range 0-27 mm).There were 72 patients with IPPL.<5 mm and 38 patients withIPPL,≥5 mm respectively.All patients received extra-peritoneal laparoscopic radical prostatectomy.Parameters describing the surgical margin status and the location of positive surgical margin was recorded.The x^2 tested the statistical significance in proportions differences.The multivariable logistic regression wasused to assess risk factors for positive surgical margin and positive base surgical margin(PBSM).Results Positive surgical margin rate was 38.1%for all patients,25 patients(22.7%)had PBSM.y testshowed that clinical stage(P<0.001)and lPPL.(P=0.038)were related to the postoperative positivesurgical margin.The clinical stage,Gleason score and IPPL.were included in the multivariate logisticregression analysis.Multiple logistic regression showed that T3 stage(P<0.001)was independent predictorfor positive surgical margin.x^2 test showed that clinical stage(P<0.001)and IPPL.(P=0.001)wererelated to the postoperative PBSM.The clinical stage,Gleason score and IPPL were included in themultivariate logistic regression analysis.T3 stage(P<0.001)and IPPL≥5 mm(P=0.009)wereindependent predictors for PBSM according to mulivariable logistic regression.Conclusions For prostatecancer patients who received laparoscopic radical prostatectomy,clinical stage T3 was an independent riskfactor for postoperative positive surgical margin.IPPL≥5 mm on preoperative magnetic resonance imagingand clinical stage T,were independent risk factors for PBSM.
作者
张帆
郝一昌
杨斌
颜野
王国良
肖春雷
张树栋
黄毅
马潞林
Zhang Fan;Hao Yichang;Yang Bin;Yan Ye;Wang Guoliang;Xiao Chunlei;Zhang Shudong;Huang YI;Ma Lulin(Department of Urologyy Peking University Third Hospital,Beijing 100191,China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2020年第9期656-660,共5页
Chinese Journal of Urology
关键词
前列腺肿瘤
切缘阳性
前列腺突入膀胱长度
前列腺切除术
腹腔镜手术
Prostatic neoplasms
Positive surgical margin
Intravesical prostatic protrusionlength
Prostatectonmy
Laparoscopic surgery
