经腹腔途径腹腔镜下根治性前列腺切除术与开放式根治性前列腺切除术的疗效比较

Comparative study of transperitoneal laparoscopic radical prostatectomy and open radical prostatectomy

目的 比较经腹腔途径腹腔镜下根治性前列腺切除术（laparoscopic radical prostatectomy,LRP）与开放式根治性前列腺切除术（open radical prostatectomy,ORP）治疗早期局限性前列腺癌的临床疗效及安全性.方法 回顾性分析2003年3月至2014年12月连续395例行根治性前列腺切除术的病例资料.根据手术方式分为两组,其中LRP组325例,ORP组70例.两组患者年龄（P=0.364）、体质指数（P =0.360）、术前前列腺特异性抗原水平（P=0.076）、术前Gleason评分（P=0.839）及前列腺体积（P=0.241）比较差异均无统计学意义.比较两组的手术时间、术中出血量、肠道功能恢复时间、术后住院时间、术中及术后并发症、术后病理情况及生化复发率等指标.结果 LRP组和ORP组手术时间分别为（114±29）、（150±39） min（P =0.002）,术中出血量分别为（248±96）、（569±166） ml（P ＜0.001）,肠道功能恢复时间分别为（2.2±0.9）、（3.0±0.8） d（P =0.031）,术后住院时间分别为（7.1±1.4）、（8.9±1.6） d（P =0.028）,组间比较差异均有统计学意义.LRP组并发症发生率显著低于ORP组（P ＜0.001）.LRP和ORP组切缘阳性率（P =0.397）及术后1、2年生化复发率（P =0.664、P=0.238）比较差异均无统计学意义.结论 腹腔镜手术治疗局限性前列腺癌具有创伤小、恢复快、并发症少等优点,在肿瘤控制方面与开放性手术具有相似的效果.

Objective To compare the clinical efficacy and safety of transperitoneal laparoscopic radical prostatectomy （LRP） and open radical prostatectomy （ORP） for treatment of localized prostate cancer.Methods From March 2003 to December 2014,395 consecutive cases of radical prostatectomy were retrospectively analyzed.The patients were divided into 2 groups：LRP group with 325 cases and ORP group with 70 cases.There were no significant differences in age （P =0.364）,body mass index （P =0.360）,preoperative PSA level （P =0.076）,preoperative Gleason score （P =0.839） and prostate volume （P =0.241） between LRP group and ORP group.Therapeutic effect was compared between the 2 groups.Results The differences of operative time （LRP：114 ± 29 min,ORP：150 ± 39 min,P =0.002）,blood loss （248 ± 96,569 ± 166 ml,P 〈 0.001）,intestinal function recovery time （2.2 ± 0.9,3.0 ± 0.8 d,P =0.031）,postoperative hospital stay （7.1 ± 1.4,8.9 ± 1.6 d,P =0.028） and complication rate（P 〈0.001） were significantly between the 2 groups.There were no significant differences in positive surgical margin rate（P =0.397） and 1-year or 2-year biochemical recurrence rate （P =0.664,P =0.238） between the 2 groups.Conclusion In the present cohort,compared with open surgery,LRP had advantages of fewer traumas,quicker recovery and fewer complications,while the tumor control was similar.