耻骨后顺行与逆行根治性前列腺切除术治疗前列腺癌疗效比较

Comparison of the efficacy between retropubic anterograde and retrograde radical retropubic prostatectomy in the treatment of prostate cancer

目的:比较耻骨后顺行与逆行根治性前列腺切除2种手术方式治疗局限性前列腺癌(PCa)的疗效和安全性。方法:用耻骨后顺行与逆行根治性前列腺切除2种术式治疗局限性PCa各35例,比较2组年龄、前列腺体积、前列腺特异抗原、Gleason评分、术中出血量、手术时间、术后病理分期、术后随访时间、手术并发症、术后最大尿流率、术后性生活恢复例数、生化复发时间和生化复发例数。结果:2组均无死亡病例。2组年龄、前列腺体积、前列腺特异抗原、Gleason评分、病理分期、手术并发症、术后随访时间、术后最大尿流率、术后性生活恢复例数、术后并发症发生情况和生化复发例数差异均无统计学意义(P>0.05),但顺行根治性前列腺切除治疗局限性PCa术中手术时间和术中出血量明显少于逆行根治性前列腺切除术(P<0.01),最大尿流测定时间、生化复发时间均短于逆行根治性组(P<0.05~P<0.01)。结论:耻骨后顺行与逆行根治性前列腺切除术均是治疗局限性PCa安全、有效的方法,但顺行根治性前列腺切除术治疗局限性PCa比逆行根治性前列腺切除术的术中出血更少,手术时间更短。

ObjectiveTo compare the efficacy and safety of antegrade and retrograde radical retropubic prostatectomy in the treatmentof localized prostate cancer. Methods：Seventy patients with localized prostate cancer were randomly divided into the antegrade andretrograde groups（35 cases each group）,and treated with antegrade and retrograde radical retropubic prostatectomy,respectively. Theage,prostate volume,prostate-specific antigen,Gleason score,peroperative bleeding,operation time,postoperative pathological staging,following-up time,operation complication,and postoperative maximum urinary flow rate,sexual life recovery,biochemical recurrent timeand number between two groups were compared. Results：No death in two groups was found. The differences of the age,prostate volume,prostate-specific antigen, Gleason score, pathological staging, following-up time, operation complication, and postoperative maximumurinary flow rate, biochemical recurrent number and sexual life recovery between two groups were not statistically significant （ P 〉0. 05）. The operation time and peroperative bleeding in antegrade group were significantly less than those in retrograde group（ P 〈0. 01）,and the time of detecting maximum urinary flow and biochemical recurrent time in antegrade group were significantly shorterthan those in retrograde group（P 〈 0. 05 to P 〈 0. 01）. Conclusions：Both antegrade and retrograde radical retropubic prostatectomy inthe treatment of localized prostate cancer are safe and effective,and the peroperative bleeding and operation time in patients treated withantegrade radical retropublic prostatectomy are less and shorter compared with retrograde radical retropublic prostatectomy.