腹腔镜筋膜内与筋膜外前列腺癌根治术近期疗效比较

Short-term curative effect of intrafascial nerve-sparing laparoscopic vs. extraperitoneal radical prostatectomy

目的比较经腹膜外途径腹腔镜筋膜内前列腺癌根治术相对于筋膜外前列腺癌根治术在近期治疗效果方面的优劣,评价其临床价值。方法回顾性分析接受同一术者施行的经腹膜外途径腹腔镜前列腺癌根治术治疗的39例患者的临床资料,其中行腹腔镜筋膜内前列腺癌根治术(筋膜内组)20例,筋膜外前列腺癌根治术(筋膜外组)19例。结果 39例手术均获得成功,两组患者在年龄、血清前列腺特异性抗原(PSA)值、前列腺大小、Gleason评分、手术时间、术中出血量、术后进食、住院总费用、术后并发症及切缘阳性率均无明显差异。筋膜内组患者在术后住院时间、术后3月尿控恢复情况及术后6、12月性功能恢复情况方面明显优于筋膜外组患者,差异有统计学意义(P<0.05),而术后6月、12月尿控恢复情况两组患者差异无统计学意义(P>0.05)。结论腹腔镜下筋膜内前列腺癌根治术在手术时间、术中出血量、切缘阳性率等方面可取得与筋膜外前列腺癌根治术相当的效果,对于较年轻、肿瘤分期为cT1~cT2术前性功能正常的患者,腹腔镜下筋膜内前列腺癌根治性切除术是一种值得推荐的手术方式。

Objective To compare the short-term curative effects of intrafascial nerve-sparing laparoscopic extraperitoneal radical prostatectomy with standard laparoscopic extraperitoneal radical prostatectomy.Methods Clinical data of 39 cases of prostate tumor were retrospectively reviewed,including 20 cases treated with intrafascial nerve-sparing laparoscopic extraperitoneal radical prostatectomy（group A）,and 19 cases treated with standard laparoscopic extraperitoneal radical prostatectomy（group B）.Results All operations were successful.There were no significant differences in operation time,volume of bleeding,bowel function recovery,hospital costs,complications and positive surgical margins between the 2 groups.However,group A showed superiority in the recovery of continence after 3 months,and in sexual function after 6 months.There was no significant difference in the recovery of continence between the 2 groups after 6 and 12 months.Conclusion Intrafascia nerve-sparing laparoscopic extraperitoneal radical prostatectomy have similar results in terms of operation time,bleeding volume,positive surgery margin as standard laparoscopic extraperitoneal radical prostatectomy,but the former preserves the neurovascular bundles and urinary sphincter effectively,thus can significantly improve continence and sexual function.For relatively young patients with tumor stage cT1-cT2,who had normal sexual function in preoperative assessment,intrafascia nerve-sparing laparoscopic extraperitoneal radical prostatectomy is worth of popularized.