3D腹腔镜与2D腹腔镜前列腺癌根治术的对比研究

Comparative evaluation of 3D and 2D laparoscopic radical prostatectomy

目的 总结3D腹腔镜下前列腺癌根治术的手术方法,比较3D腹腔镜与2D腹腔镜下前列腺癌根治术的疗效。方法 回顾性分析2012年3月至2014年2月,我院66例行腹腔镜下前列腺癌根治术患者的临床资料,其中3D腹腔镜组43例,2D腹腔镜组23例,对比两种术式在手术时间、术中出血量、术后平均住院时间、术后尿失禁比例及保留勃起功能成功率等指标的差异。结果66例前列腺癌根治术均在腹腔镜下完成。3D腹腔镜组手术时间为65~125min,平均95min;术中出血30~150ml,平均60ml;术后平均住院时间为8d;术后轻度尿失禁7例（16.28%）;术中保留性神经27例,保留勃起功能成功率为37.04%。2D腹腔镜组手术时间为74~146min,平均112min;术中出血66~196ml,平均110ml;术后平均住院时间为8.5d;术后轻度尿失禁5例（21.74%）;术中保留性神经11例,保留勃起功能成功率为27.27%。66例术后病理均证实为前列腺癌,Gleason评分4~9分,无切缘阳性。术后随访2~23个月,5例生化复发。结论 与2D腹腔镜比较,在高清3D立体视野下完成的3D腹腔镜下前列腺癌根治术,解剖层次更加清晰,分离更为精细,缝合更为精确。

Objective To summarize the experiences of 3D laparoseopic radical prostatectomy and to compare the efficacy of 3D and 2D laparoscopic radical prostatectomy. Methods We retrospectively analyzed 66 cases （from Mar. 2012 to Feb. 2014） of laparoseopic radical prostatectomy. 43 cases accept 3D laparoscopic radical prostatectomy and 23 cases 2D laparoscopic radical prostatectomy. We compared the mean operation duration, mean blood loss, mean hospital stay, incontinence rate and the emission success rate of retaining rectile function between the two groups. Results 66 eases were performed with laparoscopic procedure. The mean operation duration was 95 rain （from 65to 125 min）, mean blood loss was 60 ml （from 30 to 150 ml） and mean hospital stay were 8 days in 3D group. There were 7 cases with little uroclepsia （16.28 % ）. We retained the neurovaseular bundle in 27 cases, and the potence rate 37.04%. The mean operation duration was 112 min （from 74 to 146 min）, mean blood loss was 110 ml （from 66 to 196 ml） and mean hospital stay were 8.5 days in 2D group. There were 5 cases with little incontinence （21.74 % ）. We retained the neurovascular bundle in 11 cases, and the potence rate 27.27%. The pathologic examination in 66 cases demonstrated the prostate cancer, and Gleason score was from 4 to 9. None of the margin was positive. All the cases were followed up from 2 months to 23 months. The biochemical recurrence was 5/66, who had undergone endocrine therapy eventually. Conclusions Compared with 2D laparoscopic, 3D laparoscopic radical prostatectomy could make anatomic compartments clearer, surgical separation more meticulous and suture more accurate. It diminishes haemorrhage in surgery and complication post surgery.