腹腔镜下前列腺癌根治术经膀胱前入路与膀胱后入路疗效比较。

Laparoscopic radical prostatectomy： transperitoneal anterior bladder approach versus transperitoneal posterior bladder approach

目的探讨腹腔镜下前列腺癌根治术（LRP）经膀胱前入路与膀胱后入路的优缺点。方法回顾分析59例LRP围手术期资料和术后肿瘤学及排尿功能情况。患者平均年龄66岁。均经穿刺活检诊断为前列腺癌，TNM分期为T1a～T3b，Gleason评分3～8。分为膀胱后入路组25例，膀胱前入路组34例。2组患者年龄、体质量指数、PSA值、Gleason评分差异无统计学意义。统计学分析比较2组患者术前、术中和术后临床参数和并发症发生率、术后肿瘤学和排尿状况。结果59例手术均获成功。后入路和前入路2组患者术中平均出血量分别为（642．0±552．7）和（637．1±370．8）ml、并发症发生率分别为4．O％和2．9％、切缘阳性率分别为24．oH和20．6％。2组患者术后3个月控尿率分别为72％和88％、6个月控尿率分别为88％和91％，差异均无统计学意义（P〉O．05）。前入路组平均前列腺切除时间（174．2±58．0）min，后入路组（224．8±66．7）min，差异有统计学意义（P〈0．01）。前人路组术后平均恢复时间（5．9d）与后入路组（7．5d）比较差异有统计学意义（P〈0．05）。结论LRP经膀胱前入路较膀胱后入路前列腺切除时间和术后恢复时间短，具有临床应用优势。

Objective To compare perioperative parameters, as well as the oncological and functional results, for laparoscopic radical prostatectomy （LRP） performed via the posterior bladder and anterior bladder approaches. Methods The recorded pre-, peri-, and postoperative parameters and complications, and evaluated the oncological and functional results were collected and compared be- tween the posterior bladder approach （n= 25） and the anterior bladder approach （n= 34）. Results There were no significant differences regarding the preoperative characteristics of the two groups. The mean blood loss, complications, positive surgical margins, and continence showed no significant differences between the 2 groups at 3 and 6 months postoperatively. The mean operation time was sig- nificantly shorter in anterior bladder approach group （174.2±58.0 rain） than in posterior bladder ap- proach group （224.8±66.7 min）, （P〈0.01）. Also, the postoperative recovery time until discharge was 5.9 d in anterior bladder approach group, which was significantly shorter than in posterior bladder approach group （7.5 d） （P〈0.05）. Conclusion The anterior bladder approach yields shorter operation time and postoperative recovery period than posterior bladder approach for LRP.