三孔法腹腔镜根治性前列腺切除术治疗局限高危前列腺癌的临床研究

doi:10.19558/j.cnki.10-1020/r.2019.01.007

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摘要目的探讨三孔法腹腔镜下根治性前列腺切除术（LRP）治疗局限高危前列腺癌的临床效果,并总结手术经验。方法回顾性分析2017年1月–2018年5月行LRP治疗局限高危前列腺癌患者的临床资料,分为三孔法（即省略右髂前上棘内侧的套管）和四孔法两组。结果所有患者手术均获得成功,无严重并发症发生。三孔法平均手术时间（171.1±44.2）min,略低于四孔法（208.8±32.0）min（P<0.05）,两组平均血红蛋白下降量、术后引流管拔除时间、术后平均住院时间及切缘阳性率方面组间比较差异无统计学意义。随访3~12个月,三孔法和四孔法两组术后3个月尿失禁发生率分别为41.7%、50.0%,术后6个月尿失禁发生率为25.0%、31.3%。三孔法生化复发3例,四孔法生化复发6例,均给予内分泌治疗,影像学检查未见肿瘤复发或转移。结论三孔法LRP治疗局限高危前列腺癌安全、可行,与四孔法相比,手术时间相对较短,术中出血、术后住院时间、切缘阳性率、短期控瘤效果及尿控恢复情况等类似。

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	沈洲
	葛庆宇
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	肖峻
	宣强

关键词 ：腹腔镜, 根治性前列腺切除术, 高危, 前列腺癌

Abstract：Objective： To discuss the efficacy and summarize the operation experience of three-port laparoscopic radical prostatectomy (LRP) in the treatment of localized high-risk prostate cancer. Methods： We retrospectively analyzed the data of patients with localized high-risk prostate cancer who were treated with LRP at our institutes from Jan. 2017 to May 2018. The patients were divided into two groups: three-port group (n=14) and four-port group (n=20). Three-port LRP was characterized by the omission of the trocar placed medial to the right anterior superior iliac spine. Results： The operations were performed successfully in all patients, without serious complications. The mean operation time in three-port group [(171.1±44.2) min] was significantly shorter than that in four-port group [(208.8±32.0) min] (P<0.05). There were no statistically significant differences in the mean decrease of hemoglobin, postoperative drainage time, postoperative hospital stay and positive surgical margin rate between the two groups. Over a follow-up period of 3-12 months, the incidence of urinary incontinence at the 3rd month after surgery was 41.7% and 50.0% in the two groups, and 25.0% and 31.3% at the 6th month after surgery, respectively. Three cases in three-port group and 6 in four-port group had biochemical recurrence respectively, and all of them were treated with endocrine therapy. There was no local recurrence or metastasis. Conclusions： Three-port LRP is a feasible, safe and effective treatment for patients with localized high-risk prostate cancer. Compared with four-port LRP, three-port LRP provided shorter operation time, and similar blood loss, postoperative hospital stay, short-term oncological and urinary functional outcomes.

Key words： laparoscope radical prostatectomy high-risk prostate cancer

收稿日期: 2018-08-23

ZTFLH:

R737.25

基金资助:安徽省自然科学基金资助项目（1708085QH179）

通讯作者: 宣强, 93873951@qq.com

引用本文:

沈洲, 葛庆宇, 夏开国, 徐从云, 肖峻, 宣强. 三孔法腹腔镜根治性前列腺切除术治疗局限高危前列腺癌的临床研究[J]. 微创泌尿外科杂志, 2019, 8(1): 29-32.
SHEN Zhou, GE Qingyu, XIA Kaiguo, XU Congyun, XIAO Jun, XUAN Qiang. Clinical study of three-port laparoscopic radical prostatectomy in patients with localized high-risk prostate cancer. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2019, 8(1): 29-32.

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http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/abstract/abstract1475.shtml 或 http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/Y2019/V8/I1/29