腹腔镜前列腺癌根治术+扩大盆腔淋巴结清扫治疗高危前列腺癌临床体会

Clinical experience of laparoscopic radical prostatectomy and extended pelvic lymph node dissection for high risk prostate cancer

目的探讨腹腔镜前列腺癌根治术+扩大盆腔淋巴结清扫治疗高危前列腺癌的临床疗效,寻求更为合理的治疗方法。方法回顾性分析2014年1月至2017年10月我院泌尿外科收治的86例高危前列腺癌患者的临床资料,患者年龄46~84岁,平均69.4岁。术前tPSA 4.110~141.910ng/ml,平均37.880ng/ml,其中>20.000ng/ml 52例、>100.000ng/ml 9例。Gleason评分≥8分44例。前列腺体积11.61~109.20ml,平均40.08ml。全身骨扫描排除骨转移后行腹腔镜下前列腺癌根治术+扩大盆腔淋巴结清扫术,术后定期门诊随访tPSA、尿控等情况。结果手术均顺利完成,平均手术时间200min,术中平均出血量264ml。常规2周拔除导尿管,术后住院4~22d,平均11.9d。术后病理分期pT2a^pT2b9例、pT2c41例、pT3a14例、pT3b17例、pT45例,Gleason评分≥8分42例。清扫出淋巴结8~28枚,平均13.5枚,淋巴结转移者13例,阳性淋巴结共48枚。切缘阳性19例。随访3~48个月,平均18.2月,术后辅助内分泌治疗43例、放疗28例,出现生化复发23例。拔除导尿管后1个月内恢复尿控39例(45.34%),3个月内恢复尿控62例(72.09%),1年内恢复尿控82例(95.34%)。术后6周tPSA 0.000~2.150ng/ml,平均0.150ng/ml。术后3个月tPSA 0.000~0.170ng/ml,平均0.027ng/ml。结论腹腔镜前列腺癌根治术+扩大盆腔淋巴结清扫术是高危前列腺癌的重要治疗手段,疗效较为满意,且能提供精确的肿瘤及淋巴结病理分期。

Objective To discuss the clinical outcomes of laparoscopic radical prostatectomy and extended pelvic lymph node dissection （LRP＋cPLND） for high risk prostate cancer. Methods We retrospectively reviewed the clinical data of 86 patients with high risk prostate cancer treated in the first affiliated hospital of Soochow University from January 201d to October 2017. The mean age was 69.4 years okl （range, 46 04 ）. In the preoperative examination, the average tPSA was 37.880 ng/ml （range, 4.110- 141.910）, in which 52 cases〉20.000 ng/ml and 9 cases〉100.000 ng/ml. As to the Gleason score, dd patients were found ~8. The mean volume of prostate was d0.08 ml （range, 11.61 109.20）. All the patients underwent LRP＋cPLND and were followed up in the out patient de partment after surgeries. Results The mean time of surgeries was 200 rains and the mean blood loss was 264mL. The catheter was removed on the 14th post operative clay and the post operative hos pital stay ranged from 4to 22 days, with an average of 11.9 days. Pathological results showed pT2a-pT2b in 9 patients, pT2c in 41 patients, pT2a. in 14 patients, pTb in 17 patients, pT, in 5 patients and Gleason score ≥8 in 42 patients. An average of 13.5 （range, 8 28） lymph nodes were retrieved, 13 patients had nodal metastases with a total of 48 positive nodes, and positive margin represented in 19 patients. All the patients were followed up for 3 to 48 months. A total of 43 patients received andro gen deprivation therapy, 28 patients received radiotherapy after surgeries and 23 patients represented biochemical recurrence during the follow up period. Thirty-nine （45.34%）, 62 （72.09%） , 82 （95.34%） patients recovered in continence after being removed the catheter in one month, three months and one year respectively and the mean post operative tPSA in the 6th week and 3nd month were 0.150 ng/ml （range, 0.000 2.150） , 0.027 ng/ml （range, 0.000 0.170）. Conclusions LRP＋cPLND represents an effective procedure in high risk prostate cancer, and it provides superior accuracy for postopera tive pathological tumor and regional lymph node staging as well.