腹腔镜和开放前列腺癌根治术后配对比较切缘阳性情况

Status of surgical margin:laparoscopic versus open radical prostatectomy

目的通过配对比较腹腔镜和开放性前列腺癌根治术两种不同手术方式,明确术后切缘阳性的影响因素。方法回顾性分析我院2012年12月至2014年7月行前列腺癌根治术230例患者,其中行开放手术136例,腹腔镜94例,术后通过前列腺整体组织大切片的方式由我院泌尿病理医师阅片评估术后切缘阳性情况及部位。结果通过倾向指数评分配对比较腹腔镜和开放手术效果,其中腹腔镜94例占40.9%。根据患者年龄、PSA水平和穿刺Gleason评分进行配对,最终选取腔镜和开放手术患者各94例进行分析。两组人群的年龄、PSA水平、穿刺Gleason评分和病理T分期均无显著差异。年龄、PSA、穿刺Gleason综合、T分期和手术方式5个变量进行多因素分析,可发现仅有术后病理T分期可作为切缘阳性的独立预后因素。无论是总体切缘阳性率还是不同部位的切缘阳性率,腹腔镜手术和开放手术相比均没有显著差异(P>0.05)。结论两组人群的手术切缘阳性率没有显著性差异,提示腹腔镜手术提供了不劣于开放手术的肿瘤切除的完整性。

Objective To evaluate the positive surgical margin of laparoscopic and open radical prostatectomy by pairing comparison analysis .Methods A retrospective analysis of 230 consecutive radical prostatectomy cases treated at our center during Dec .2012 and Jul .2014 was conducted ,among which 136 cases were open and 94 were laparoscopic operations .Postop-erative whole mount slides were reviewed by urinary pathologists to evaluate positive surgical margin status and positions .Re-sults The propensity score matching index was used to evaluate laparoscopic and open surgery patients .Paired matching was conducted according to patient age ,PSA level and biopsy Gleason score .As a result ,94 pairs of laparoscopic and open surgery patients were selected .There were no statistical difference in age ,PSA level ,Gleason score ,and pathological T stage between the two groups .Only T stage was found to be an independent prognostic factor of positive surgical margin .There were no sig-nificant differences （P〉0 .05） in the overall rate of positive margins or positive rate of different parts between the two groups . Conclusions There is no significant difference in the positive rate of surgical margin of the two groups ,suggesting that lapa-roscopic operation is not inferior to the open operation in tumor resection and integrity .