3D腹腔镜与传统腹腔镜经腹腔根治性前列腺切除术比较

3D versus 2D laparoscopic radical prostatectomy for the treatment of prostate cancer

目的:对比3D和2D腹腔镜根治性前列腺切除术的差异。方法:回顾性分析50例因前列腺癌接受腹腔镜根治性前列腺切除术的患者,其中接受3D经腹腹腔镜根治性前列腺切除术者18例,接受传统2D经腹腹腔镜根治性前列腺切除术者32例。比较两组患者一般资料和手术时间、出血量、术后住院时间、术后病理分期、并发症发生情况、随访情况等临床资料的差异。结果:所有患者均顺利完成手术,无中转开放手术。两组患者年龄、体质指数(BMI)、穿刺活检的Gleason评分及临床分期均具有可比性。与常规2D腹腔镜手术时间[(180.2±69.1)min]、术中出血量[(236.5±60.6)ml]、术后引流时间[(7.1±1.1)d]、术后住院时间[(20.2±5.5)d]相比,3D腹腔镜手术时间[(118.3±55.1)min]、术中出血量[(89.1±35.2)ml]、术后引流时间[(5.3±2.1)d]、术后住院时间[(14.4±7.2)d]以及围手术期并发症均明显减少(P均<0.01)。两组患者术后病理切缘均阴性,且术后6个月尿控均完全恢复。结论:3D腹腔镜增加手术的精确性,在保证治疗效果的同时不增加患者的负担,值得在基层医院广泛推广。

Objective：To compare the outcomes and complications of 3D versus 2D laparoscopic radical prostatectomy（LRP）in the treatment of prostate cancer.Methods：We retrospectively reviewed 18 cases of prostate cancer treated by 3D LRP and another32 by 2D LRP.We compared the general data,intraoperative blood loss,postoperative drainage time and hospital stay,Gleason scores,and incidence of complications between the two groups of patients.Results：All the operations were successful and none was transferred to open surgery.The two groups of patients were similar in terms of age,body mass index,Gleason scores,and clinical stages.However,compared with the 2D LRP group,the 3D LRP group showed significantly shorter operation time（[180.2 ± 69.1] vs[118.3 ± 55.1]min,P 〈0.01）,less blood loss（[236.5 ± 60.6]vs [89.1 ± 35.2]ml,P 〈0.01）,less postoperative drainage time（[7.1 ± 1.1]vs [5.3 ± 2.1]d,P 〈0.01）,shorter postoperative hospital stay（[20.2 ± 5.5]vs [14.4 ± 7.2]d,P 〈0.01）,and lower incidence of perioperative complications（3.1% vs 0,P 〈0.01）.The incisal margin was pathologically negative in both groups and urinary incontinence was found in neither at 6 months after surgery（P 〉0.05）.Conclusion：3D LRP,with its advantages of shorter operative time,faster recovery,and better outcomes than 2D LRP in the treatment of prostate cancer,deserves general application in lower-level hospitals.