传统2D腹腔镜与3D腹腔镜下前列腺癌根治手术疗效比较

Comparative evaluation between 2D and 3D laparoscopic radical prostatectomy

目的比较传统2D腹腔镜与3D腹腔镜下前列腺癌根治手术疗效。方法回顾分析苏州大学附属第一医院泌尿外科2015年4月至2016年4月施行的110例腹腔镜下前列腺癌根治术患者的资料,其中3D腹腔镜组48例,2D腹腔镜组62例。对两组患者的手术时间、术中输血率、性神经保留、切缘阳性率、术后引流天数、术后6个月尿失禁比例、术后住院天数进行比较分析。结果两组患者均成功实施手术,无中转开放手术。3D腹腔镜组在手术时间、术中输血率、性神经保留及术后尿控方面均较2D腹腔镜组有明显优势(P<0.05),在术后引流天数、术后住院天数、切缘阳性率等方面两组手术未见明显统计学差异(P>0.05)。术中均未行标准或扩大的淋巴结清扫,术后病理均证实为前列腺癌,Gleason评分6~9分,与术前临床分期基本一致。结论与2D腹腔镜下前列腺癌根治手术比较,3D腹腔镜系统手术疗效更明显,在保留性神经及术后6个月的尿控方面也更具优势,值得在难度较大的手术上推广使用。

Objective To compare the efficacy between 2 Dand 3 Dlaparoscopic radical prostatectomy. Methods We retrospectively analyzed 110 cases（from Apr.2015 to Apr.2016）undergoing laparoscopic radical prostatectomy.Sixty-two cases were treated with 2 Dlaparoscopic radical prostatectomy（2 Dgroup）,while others were treated with 3 Dlaparoscopic radical prostatectomy（3 D group）.We compared the operative time,intraoperative blood transfusion rate,sexual nerve preservation,positive surgical margins,postoperative drainage days,postoperative 6 months urinary incontinence and postoperative hospitalization days between the two groups. Results The two groups were successfully operated with no open surgery conversion.The operative time,intraoperative blood loss,sexual nerve preservation and postoperative urine control in the 3 Dgroup were significantly superior to those in the 2 Dgroup（P〈0.05）.There was no significant difference in the postoperative drainage days,positive surgical margins and postoperative hospitalization days between the two groups（P〉0.05）.No standard or enlarged lymph node dissection was performed during the operation,and prostate cancer was confirmed by pathology after operation.The Gleason score was 6-9 points,which was basically the same as the preoperative staging Conclusions Compared with 2 D laparoscopic radical prostatectomy,3 Dlaparoscopic surgery is more effective.Retention of nerves and urine control for 6 months after operation are more advantageous.It is worth popularizing in difficult operation.