腹腔镜根治性前列腺切除术后切缘阳性的相关因素分析

Risk Factors Analysis for Positive Surgical Margins in Laparoscopic Radical Prostatectomy

目的:分析腹腔镜根治性前列腺切除术后切缘阳性的相关因素。方法:2004年1月～2010年12月,我院完成腹腔镜根治性前列腺切除术188例,平均年龄72岁。患者根治术前均经病理检查确诊为前列腺癌,未发现肿瘤转移征象。采用单因素分析研究各参数对切缘情况的影响,采用多因素Logistic回归分析确定切缘阳性的独立危险因素。结果:除2例患者中转开放手术外,其余患者均在腹腔镜下完成手术。平均手术时间246min,平均出血量309ml。术后病理回报切缘阳性76例,占40.5%。单因素分析提示切缘阳性组与切缘阴性组穿刺Gleason评分、穿刺阳性针数、根治病理Gleason评分、病理分期差异有统计学意义(P<0.05)。多因素Logistic回归分析显示根治标本Gleason评分、病理分期是切缘阳性的独立相关因素。根治标本Gleason评分8分相对于Gleason评分6分患者切缘阳性风险增高1 7.1倍(比值比为1 7.1 31,95%置信区间为5.237～56.037,P<0.001),病理分期T_3期相对于T_2期患者切缘阳性风险增高9.0倍(比值比为8.970,95%置信区间为4.1 28～1 9.493,P<0.001)。结论:根治标本Gleason评分、病理分期是腹腔镜根治性前列腺切除术后切缘阳性独立危险因素。根治标本Gleason评分为8分、病理分期为T_3期患者的切缘阳性率显著增高。

Objective：To analysis the risk factors for positive surgical margins in laparoscopic radical prostatectomy. Methods：We retrospectively analyzed the clinical and pathological data of 188 cases, who received laparo- scopic radical prostatectomy from Jan. 2004 to Dec. 2010 in our hospital. The patients average 72 years old. All patients were dignosised by pathology before prostatectomy, and no metastasis was found before surgery. Univariable analyse were used to estimate the relationship between the parameters and surgical margin status. Multivariable logistic regression analyse were used to determine relative risk factors for positive surgical margins. Results： Except that two patients were converted to open surgery, laparoscopic radical prostatectomy was successfully applied in other 186 patients. The operating time was average 246 min, the blood loss during operation was average 309 ml. 76 cases （40.5%） had positive surgical margin. Result from univariable analyse showed there were significance difference between positive and negtive surgical margins patients on biopsy Gleason score, number of positive biopsy cores, surgical Gleason score, and pathological stage. On multivariable logistic regression analyses, surgical Gleason score and pathological stage were independent factor of positive surgical margins. A surgical Gleason score more than 7 was associated with a 17.1-fold higher chance of positive surgical margin than a surgical Gleason score not more than 6 （OR：17. 131, 95%CI：5. 237-56. 037,P〈0. 001）. A pathological stage of T3 was associated with a 9.0-fold higher risk of positive surgical margin than a psthology stage of T2 （OR：8. 970, 95 % CI： 4. 128-19. 493,P〈0. 001）. Conclusions：Surgical Gleason score and pathological stage were independent factors of positive surgical margins in laparoscopic radical prostatectomy. Patients with surgical Gleason score more than 7 and pathological stage of 73 had a higher rate of positive surgical margins.