经腹膜外腹腔镜下与开放性前列腺癌根治术的临床比较

Clinical comparison of extraperitoneal laparoscopic radical prostatectomy and open radical prostatectomy for prostate cancer

目的比较开放性前列腺癌根治术(open radical prostatectomy,ORP)与经腹膜外腹腔镜下前列腺癌根治术(extraperitoneal laparoscopic radical prostatectomy,ELRP)的临床疗效。方法回顾性分析行前列腺癌根治术的患者65例。ORP组38例行ORP治疗,ELRP组27例行ELRP治疗,比较两组患者术前、围手术期及术后各项指标。结果 ELRP组患者均获成功,无术中转开放手术,手术时长为(135.0±31.7)min,与ORP组的(147.0±40.3)min比较,差异无统计学意义(P>0.05)。ELRP组出血量为(210±80)m L,少于对照组的(470±100)m L(P<0.05)。在术后住院恢复期中,ELRP组的术后肠功能恢复时间、卧床时间以及住院时间均少于ORP组[(12.1±7.8)h、(9.9±6.7)h、(7.9±2.2)d vs(40.7±10.4)h、(36.3±11.9)h、(15.2±3.4)d,均P<0.05]。ORP组尿漏、尿失禁、吻合口狭窄及勃起功能障碍等并发症发生率为63.2%(24/38),而ELRP组并发症发生率为51.9%(14/27),两组比较差异无统计学意义(P>0.05)。随访10~12年,两组在完全控尿率及生化复发率方面差异均无统计学意义(均P>0.05)。结论相较于ORP,ELRP是一种更安全有效的前列腺癌根治术术式。术后患者肠功能恢复快、下床时间早、住院时间短,长期随访两者术后完全尿控率及生化复发率无差异。

Objective To compare the clinical efficacy of open radical prostatectomy（ ORP） and extraperitoneal laparoscopic radical prostatectomy（ ELRP） for prostate cancer. Methods The clinical data of 65 cases of prostate cancer patients who have received radical resection were retrospectively analyzed. Among them,27 patients underwent ELRP and38 patients underwent ORP. Preoperative,perioperative and postoperative indexes were compared between the two groups.Results For all 27 cases of patients who underwent ELRP,the operations were successfully performed,and no patient was converted to open surgery. The mean operation time for the ELRP group was comparable with that of the ORP group[（ 135. 0 ± 31. 7） min vs（ 147. 0 ± 40. 3） min,P〉0. 05]. However,the mean bleeding volume during operation for the ELRP group was significantly less than that for the ORP group [（ 210 ± 80） m L vs（ 470 ± 100） m L,P〈0. 05]. Besides,the postoperative intestinal function recovery time,bed lying time,and hospitalization length of the ELRP group were all significantly shorter than those of the ORP group [（ 12. 1 ± 7. 8） h vs（ 40. 7 ± 10. 4） h,（ 9. 9 ± 6. 7） h vs（ 36. 3 ± 11. 9） h,（ 7. 9 ± 2. 2） d vs（ 15. 2 ± 3. 4） d; all P〈0. 05]. Moreover,the incidence of adverse complications,such as urine leakage,uroclepsia,stoma stricture and erection dysfunction,was 63. 2%（ 24/38） in the ORP group and 51. 9%（ 14/27） in the ELRP group. There was no significant difference of the adverse complication rates between the two groups（ P〉0. 05）.Finally,no significant difference of the continence rate or biochemical recurrence rate was observed between the two groups during 10 to 12 years follow-up. Conclusions ELRP is a more secure and efficient surgical approach than ORP for the radical resection of prostate cancer. Patients who received ELRP tend to have quicker intestinal function recovery,less bedlying time and shorter hospitalization length. Long-term follow-up suggested that the continence rate and biochemical recurrence rate are comparable between patients receiving ORP and ELRP.