经腹膜外入路和经腹腔入路腹腔镜前列腺癌根治术的效果对比

Comparison of laparoscopic radical prostatectomy through extraperitonealapproach and peritoneal approach

目的:探讨经腹膜外入路和经腹腔入路下行腹腔镜前列腺癌根治术(LRP)的效果差异及其对患者氧化应激指标的影响。方法:将100例前列腺癌患者根据手术方法分为经腹膜外入路腹腔镜前列腺癌根治术(ELRP组,53例,经腹膜外入路)和经腹腔入路腹腔镜前列腺癌根治术(TLRP组,47例,经腹腔入路)。观察两组术后尿流动力学指标、氧化应激水平以及并发症情况,分析两组术后1年复发率的差异。结果:ELRP组的手术耗时、出血量、尿管移除时间、胃肠功能恢复时间以及平均住院时间均显著小于TLRP组(P<0.05);ELRP组患者术后膀胱顺应性、剩余尿量、最大尿流率、最大尿流时逼尿肌压力及血超氧化物歧化酶、丙二醛、皮质醇水平均优于TLRP组(P<0.05)。两组患者术后并发症情况及术后1年复发率差异无统计学意义(P>0.05)。结论:ELRP对腹腔器官影响小、出血量少,可有效促进患者尿流动力学恢复和减少氧化应激反应。

Objective:To investigate the effect of laparoscopic radical prostatectomy(LRP)through peritoneal approach and peritoneal approach on oxidative stress in patients.Methods:The clinical data of 100 patients with pros⁃tate cancer from January 2013 to January 2018 were retrospectively analyzed.Those patients were divided into ELRP group(53 cases,extraperitoneal approach)and TLRP group(47 cases,transperitoneal approach)according to the surgical procedures.The urodynamics indexes,oxidative stress levels and complications were observed in two groups.The differences of recurrence rate were analyzed one year after operation.Results:The operation time,blood loss,catheter removal time,gastrointestinal function recovery time and hospitalization time in the ELRP group were significantly reduced as compared with those in the TLRP group(P<0.05).Postoperative urinary flow mechanical indicators such as BC,PVR,Qmax and Pdet at Qmax in the ELRP group,as well as superoxide dismutase(SOD),malondialdehyde(MDA0,cortisol(Cor)were significantly better than in the TLRP group(P<0.05).There was no statistical difference in postoperative complications and biochemical recurrence rate between the two groups(P>0.05).Conclusion:LRP through extraperitoneal approach has little effect on abdominal organs and less blood loss,which can effectively promote the recovery of urinary flow mechanics and reduce oxidative stress.