腹腔镜下与开放式根治性前列腺切除术的比较研究

Comparison of outcomes in laparoscopic radical prostatectomy and open radical prostatectomy

目的 比较腹腔镜下根治性前列腺切除术（laparoscopic radical prostatectomy,LRP）和开放式根治性前列腺切除术（open radical prostatectomy,ORP）治疗前列腺癌的疗效和并发症.方法 回顾性分析2011年1月至2014年6月302例行LRP或ORP的前列腺癌患者资料.依据术式分为LRP组及ORP组,LRP组110例,ORP组192例.两组患者的年龄、体质指数、前列腺特异性抗原水平、Gleason评分、术前T分期、经直肠超声前列腺质量比较差异均无统计学意义（P＞0.05）.比较两组手术时间、术中估计失血量、术后留置导尿天数、术后留置引流管天数、术后住院天数、切缘阳性率以及术后3、6个月控尿恢复率.结果 ORP组和LRP组的中位手术时间分别为95 min和120 min,中位住院时间分别为9d和6d,组间比较差异有统计学意义（P＜0.01）.ORP组和LRP组的术中估计失血量分别为350 ml和250 ml,术后留置引流管天数均为3d,术后留置导尿天数分别为16 d和15 d,切缘阳性率分别为10.4％和12.7％,术后3个月控尿恢复率分别为80.2％和70.8％,术后6个月控尿恢复率分别为85.9％和87.3％,以上观察指标组间比较差异均无统计学意义（P＞0.05）.结论 与ORP相比,LRP术后住院天数较短,但手术时间延长.LRP和ORP在前列腺肿瘤的控制和术后功能恢复方面都有很好的效果,两者都是治疗前列腺癌的重要手术方式.

Objective To compare outcomes of laparoscopic radical prostatectomy （LRP） and open radical prostatectomy （ORP） performed in our hospital.Methods A non-randomized,retrospective comparative study was performed to analysis 302 prostate cancer patients from January 2011 to June 2014.One hundred and ten patients underwent LRP and 192 underwent ORP.There were no significant differences between the LRP and ORP groups with respect to patient age,body mass index,PSA level,Gleason Score,clinical T stage and transrectal ultrasonography prostate volume （P 〉 0.05）.The operating time,estimated blood loss,catheter retaining time,hospital stay time,positive surgical margin rate and urinary control rate were compared between the 2 groups.Results The median operative time of the ORP group and the LRP group was 95 min and 120 min,the difference between groups was significant （P 〈 0.01）.The median duration of hospitalization of the 2 groups was 9 d and 6 d,the difference between groups was significant （P〈0.01）.ORP group and LRP group＇s estimated blood loss was 350 ml and 250 ml.Days of tube drainage were 3 d in both groups.Days of urinary catheterization drainage after surgery were 16 d and 15 d,respectively.Positive margin rate was 10.4% and 12.7%.Urinary continence recovery rates at 3 month were 80.2% and 70.8%.Urinary continence recovery rates at 6 month were 85.9% and 87.3%.No significant difference was observed in the above index （P 〉 0.05）.Conclusions Compared with ORP,LRP has shorter hospital stay time and longer operating time.Both LRP and ORP have good outcomes in oncological control and function rehabilitation.Both of them are important procedures to treat localized prostate cancer.