腹腔镜前列腺癌根治术治疗前列腺癌的短期疗效及对患者血清PSA、VEGF、IGF-I和FPSAR水平的影响

Short-term Curative Effect of Laparoscopic Radical Prostatectomy in the Treatment of Prostate Cancer and the Influence on Serum PSA,VEGF,IGF-I and FPSAR Levels

目的探究腹腔镜前列腺癌根治术治疗前列腺癌的短期疗效及血清前列腺特异性抗原(PSA)、血管内皮生长因子(VEGF)及胰岛素样生长因子I(IGF-I)水平的影响。方法随机数字表格法将120例前列腺癌患者分为试验组与对照组,各60例,分别行腹腔镜前列腺癌根治术、开放性根治术。评价两组手术指标(手术时间、术中出血量、肠道功能恢复时间、住院时间)、疗效指标[国际前列腺症状评分(IPSS)、最大尿流率、残余尿量]及并发症情况,术前、术后1周测定各组血清总前列腺特异抗原(t-PSA)、游离前列腺特异抗原(f-PSA)、VEGF及IGF-I水平,计算f-PSA/t-PSA比值(即FPSAR)。结果手术时间试验组比对照组显著延长,术中出血量、肠道功能恢复时间、住院时间及并发症发生率比对照组均显著减少,差异有统计学意义(P <0.05);与术前比较,两组术后t-PSA、f-PSA、VEGF、IGF-I水平均显著降低,FPSAR显著上升,差异有统计学意义(P <0.05);术后1周IPSS评分、最大尿流率、残余尿量、t-PSA、f-PSA、VEGF、IGF-I、FPSAR比较差异均无统计学意义(P>0.05)。结论腹腔镜前列腺癌根治术能明显降低前列腺癌患者血清PSA、VEGF、IGF-I水平,提高FPSAR比值,短期疗效与开放性根治术相当,但腹腔镜手术相比开放性手术术中出血量少、术后恢复快、并发症少、住院时间短。

Objective To explore the short-term curative effect of laparoscopic radical prostatectomy in the treatment of prostate cancer and the influence on serum prostate specific antigen (PSA),vascular endothelial growth factor (VEGF)and insulin-like growth factor I(IGF-I)levels.Methods 120 patients with prostate cancer were divided into experimental group and control group by random number table method,with 60 cases in each group.The two groups were treated by laparoscopic radical prostatectomy or open radical resection, respectively.Operative indexes (operative time,intraoperative blood loss,intestinal function recovery time, hospital stay),curative effect indexes [International Prostate Symptom Score (IPSS ),the maximum flow rate, residual urine volume ] and complications in the two groups were evaluated.Levels of serum total prostate specific antigen (t-PSA),free prostate specific antigen (f-PSA),VEGF and IGF-I were determined before operation and at 1 week after operation.The ratio of f-PSA/t-PSA (FPSAR) was calculated.Results The operative time of the experimental group was significantly longer than that of the control group,while the intraoperative blood loss,intestinal function recovery time,hospital stay and the incidence of complications were significantly less/shorter/lower than those in the control group (P<0.05).After operation,levels of t-PSA,f-PSA,VEGF and IGF-I in the two groups were decreased significantly while FPSAR increased significantly (P<0.05).There was no significant difference in the IPSS score,the maximum urine flow rate, residual urine volume,t-PSA,f-PSA,VEGF,IGF-I or FPSAR at 1 week after operation (P>0.05). Conclusion The laparoscopic radical prostatectomy can significantly downregulatelevels of serum PSA,VEGF and IGF-I in patients with prostate cancer and improve the FPSAR ratio.The short-term curative effect is similar to open radical operation.However,compared with open operation,the blood loss during laparoscopic operation is less,patients undergoing laparoscopic operation can recover more quickly,and complications are fewer and hospital stay is shorter.