腹腔镜下前列腺癌根治术疗效及早期并发症的临床分析

Clinical outcome and early complications of laparoscopic radical prostatectomy

目的:总结腹腔镜下前列腺癌根治术(laparoscopic radical prostatectomy,LRP)的临床疗效及早期并发症发生情况。方法:回顾性分析2013年1月～2015年12月行LRP的216例前列腺癌患者的临床资料。年龄45～83岁,中位年龄68岁,BMI(23.74±2.49)kg/m^2,术前PSA 1.29～242.85ng/ml,其中<10ng/ml 62例,10～20ng/ml 83例,>20ng/ml 71例。所有病例均行超声引导下经直肠前列腺穿刺活检术确诊为前列腺腺癌,其中Gleason评分≤6分69例,7分82例,≥8分65例。临床分期:≤T_(2a)期95例,T_(2b)期39例,≥T_(2c)期82例。结果:本组平均手术时间(185.31±47.85)min,术中出血量(232.29±131.13)ml,6例(2.8%)输血,无中转开放手术。手术切缘阳性40例(18.5%)。14例(6.5%)出现手术相关并发症。术后6周复查PSA 0~1.96ng/ml,其中≥0.2ng/ml 19例(8.8%)。术后1、3、6、12个月控尿功能恢复率分别为19.4%(42/216)、58.8%(127/216)、78.7%(170/216)、91.7%(198/216)。29例行保留性神经手术,术后3、6、12个月勃起功能恢复率分别为41.4%(12/29)、58.6%(17/29)、65.5%(19/29)。术后3、6、12个月生化复发率分别为1.4%(3/216)、2.3%(5/216)、3.7%(8/216)。结论:腹腔镜下前列腺癌根治术安全、有效,术后并发症发生率低,肿瘤学结果满意,在排尿控制及勃起功能恢复方面也可获得良好的效果。

Objective：To analyze clinical outcome and early complications of laparoscopic radical prostatectomy（LRP）.Method：The clinical data and follow-up information of 216patients who underwent LRP from January2013to December 2015in our hospital were retrospectively analyzed.The median age was 68（range,45-83）years old.The mean body mass index（BMI）was（23.74±2.49）kg/m^2.The preoperative prostate specific antigen（PSA）levels were 1.29ng/ml to 242.85ng/ml.Among which,62cases indicated PSA levels less than 10ng/ml,83cases indicated PSA levels between 10ng/ml and 20ng/ml,and the rest 71cases indicated PSA levels higher than 20ng/ml.All the cases were diagnosed as prostate cancer by transrectal ultrasound guided prostate puncture biopsy.There were 69cases with Gleason score≤6,82cases with Gleason score=7and 65cases with Gleason score≥8.The classification of clinical stage in this study included 95cases in cT1c-cT2a,39cases in cT2b,and 82cases in cT2c-cT3b.Result：The mean operative time was（185.31±47.85）min and the average blood loss was（232.29±131.13）ml.Six cases（2.8%）were required transfusion and no case was converted to open surgery.There were 40cases（18.5%）with positive surgical margins.Fourteen cases（6.5%）suffered from surgery-related complications.The PSA levels were 0ng/ml to 1.96ng/ml at six weeks after the surgery and 19cases（8.8%）indicated PSA levels higher than 0.2ng/ml.Forty-two cases（19.4%）,127cases（58.8%）,170cases（78.7%）and 198cases（91.7%）experienced urinary continent at 1 month,3 months,6 months and 12months after operation,respectively.Of the nerve-sparing 29cases,satisfactory erectile function were recovered in 12cases（41.4%）,17cases（58.6%）and 19cases（65.5%）at 3months,6months and 12months after operation,respectively.The biochemical recurrence rate at 3 months,6 months and 12 months after operation were1.4%（3/216）,2.3%（5/216）and 3.7%（8/216）,respectively.Conclusion：LRP could be safe and effective in the treatment of prostate cancer.It may bring low incidence of postoperative complications,satisfactory tumor control,great urinary continence and positive recovery of erectile function.