三孔法3D腹腔镜与2D腹腔镜前列腺癌根治术的初步比较研究

Three-port laparoscopic radical prostatectomy: comparison of three dimensional (3D) versus two-dimensional (2D) laparoscopy

目的比较经腹膜外途径三孔法3D腹腔镜与2D腹腔镜下前列腺癌根治术的近期临床疗效。方法回顾性分析2014年1月至2015年12月共31例行三孔法腹膜外途径腹腔镜下前列腺癌根治术患者的临床资料,所有手术均为同一人主刀完成,其中3D腹腔镜组16例,病例来自上海市第一人民医院;2D腹腔镜组15例,病例来自嘉兴市第一医院。对比两组的手术时间,保留性神经,术中出血量,术后住院天数,手术切缘阳性率,术后生化复发率,术后尿失禁发生率等指标的差异。结果 31例前列腺癌根治术均在腹腔镜下完成。其中3D腹腔镜组均成功采用三孔法;2D腹腔镜组采用三孔法完成13例,2例中转五孔法完成。3D腹腔镜组手术时间为55~125 min,平均88 min;尿道吻合时间5~18min,平均10 min;术中出血20~200 ml,平均60 ml;术后轻度尿失禁2例（12.5%）;术中保留性神经8例（50.0%）;切缘阳性1例（阳性率6.3%）。2D腹腔镜组手术时间为80~180 min,平均105 min;尿道吻合时间10~26 min,平均15 min;术中出血30~400 ml,平均105 ml;术后轻度尿失禁3例（23.1%）;术中保留性神经4例（30.8%）;切缘阳性3例（23.1%）。31例术后病理均证实为前列腺癌,Gleason评分5~9分。术后随访4~25个月,其中4例生化复发,3D和2D腹腔镜组各2例。结论与2D相比3D腹腔镜三孔法前列腺癌根治术的解剖层次更清晰、缝合更精准、操作更简便。三孔法3D腹腔镜前列腺癌根治术具有较高的安全性和可行性。

Objective To compare the short term clinical efficacy of three-port 3D and 2D laparoscopic radical prostatectomy. Methods From January 2014 to December 2015,the data from 31 cases for prostate cancer,who had undergone three-port extraperitoneal laparoscopic radical prostatectomy by a single surgeon,were retrospectively analyzed. Among them,16 cases from Shanghai General Hospital underwent 3D laparoscopic radical prostatectomy and 15 cases from The First Hospital of Jiaxing underwent 2D laparoscopic radical prostatectomy. Compared with the two groups of operative time,anastomosis time,blood loss,nerve sparing,positive surgical resection margins,urinary incontinence,biochemical recurrence and complications. Results All of the31 cases underwent laparoscopy radical prostatectomy,and none of the cases were converted to open radical prostatectomy. 3D group successfully performed with three-port method; 13 cases in 2D group performed with three-port,2 cases converted to five-port method. The mean operative time was 88 min（ from 55 to 125 min）and 105 min（ from 80 to 180 min）,mean urethral anastomosis time was 10 min（ from 5 to 18 min） and 15 min（ from 10 to 26 min）,mean blood loss was 60ml（ from 20 to 200 ml） and 105ml（ from 30 to 400 ml）,the rate of nerve sparing was 50. 0% and 30. 8%,positive rate of surgical resection margins was 6. 3% and 23. 1%,urinary incontinence rate was 12. 5% and 23. 1% for 3D group and 2D group respectively. The overall postoperative pathology was prostate cancer and Gleason score was from 5 to 9. All cases were followed for approximately12 months（ range 4 ~ 20） and 14 months（ range 5 ~ 25） in 3D and 2D group respectively. The rate of biochemical recurrence was 12. 5%（ 2 /16） and 15. 4%（ 2 /13） in 3D group and 2D group respectively. Conclusions Compared with 2D laparoscopy,3D three-port laparoscopic radical prostatectomy is safe and feasible,which make anatomic compartments clearer,surgical separation more meticulous and suture more accurate. It diminishes haemorrhage in surgery and complication post surgery.