新辅助内分泌治疗联合腹腔镜治疗局限性前列腺癌的临床观察

Clinical observation of localized prostate cancer treated with neoadjuvant hormonal therapy plus laparoscopic radical prostatectomy

目的探讨新辅助内分泌治疗对腹腔镜前列腺癌根治术手术参数的影响,评价术前实施新辅助内分泌治疗的安全性和有效性。方法回顾性分析126例局限性前列腺癌患者的临床资料,根据治疗方式不同分为腹腔镜前列腺根治术(LRP)组和新辅助内分泌治疗(NHT)组,其中LRP组95例,NHT组31例。对比分析手术时间、出血量、切缘阳性率、住院时间、2年生化复发率和并发症等指标。结果 126例患者均顺利完成手术。LRP组和NHT组患者的平均手术时间分别为(115±25)min和(120±20)min(P>0.05),术中平均出血量分别为(110±35)ml和(116±28)ml(P>0.05),切缘阳性率分别为42.1%和19.4%(P<0.05),平均住院时间分别为(11.3±2.1)d和(13.5±3.6)d(P>0.05)。术后随访6～54个月,LRP组和NHT组的2年生化复发率分别为27.4%(17/62)和33.3%(7/21),差异无统计学意义(P>0.05)。LRP组2例(2.1%)发生直肠损伤,5例(5.3%)不同程度的尿失禁,3例(3.2%)吻合口尿漏;NHT组直肠损伤为1例(3.2%),不同程度尿失禁2例(6.5%),吻合口尿漏1例(3.2%)。此外,NHT组还发生了尿道狭窄1例(3.2%)。结论新辅助内分泌治疗不会增加局限性前列腺癌患者的手术风险;新辅助内分泌治疗能降低手术患者的切缘阳性率,但是不能降低其2年生化复发率,有效性有待进一步考察。

Objective To explore the impact of neoadjuvant hormonal therapy（NHT） on operative parameters on laparoscopic radical prostatectomy（LRP）,and evaluate the safety and efficacy of NHT prior to LRP for localized prostate cancer.Methods Retrospective analysis of 126 localized prostate cancer patients.We divided them into LRP group and NHT group based on their treatment,Of these cases,95 treated with LRP,31 treated with NHT plus LRP.Group comparison were carried out with these variables,such as operation time,blood loss,positive surgical margin,length of stay,2 years biochemical recurrence rate,etc.Results All 126 patients were operated successfully.The average operation time,blood loss,positive surgical margin,length of stay of LRP group were（115±25）min,（110±35）ml,42.1%,（11.3±2.1）day,respectively;The corresponding value of NHT group were（120±20）min,（116±28）ml,19.4%,（13.5±3.6）day.Except for positive surgical margin,there was no significant differences between these 2 groups with regard to operation time,blood loss and length of stay（P0.05）.The follow-up time was 6~54 months,2 years biochemical recurrence rates of LRP group and NHT group were 27.4%（17/62） and 33.3%（7/21）（P0.05）,respectively.2 cases rectal injury（2.1%）,5 cases uroclepsia（5.3%）,3 cases anastomotic urinary leakage（3.2%） were occurred in LRP group,the corresponding value of NHT group was 1 case（3.2%）,2 cases（6.5%） and 1 case（3.2%）,respectively;Meanwhile,NHT group also has 1 case（3.2%） of urethrostenosis.Conclusions NRT didn＇t increase localized prostate cancer patients＇ operation risk.NRT can lower patients＇ positive surgical margin rate,but show little influence on their 2 years biochemical recurrence rate,therefore,the efficacy of NRT need further investigation.