腹腔镜前列腺癌根治术与开放性前列腺癌根治术治疗早期前列腺癌疗效比较

Comparison of the effect of laparoscopic radical prostatectomy and open radical prostatectomy in the treatment of early prostate cancer

目的比较腹腔镜前列腺癌根治术与开放性前列腺癌根治术治疗早期前列腺癌的临床效果及安全性。方法选择2013年9月至2016年1月新乡医学院第一附属医院收治的早期前列腺癌患者48例,根据治疗方法分为腹腔镜手术组(n=28)和开放性手术组(n=20)。开放性手术组患者行开放性前列腺癌根治术,腹腔镜手术组患者行腹腔镜前列腺癌根治术。记录2组患者的手术时间、术中出血量、住院时间、引流管留置时间、导尿管留置时间及胃肠功能恢复时间;观察2组患者术后并发症发生情况;术后6个月,使用B型超声测定患者排泄后残留尿量(PVR),尿动力学分析仪检测患者最大尿流率(Qmax),并对2组患者进行国际前列腺症状评分(IPSS);所有患者术后随访2a,观察术后生化复发情况。结果腹腔镜手术组患者手术时间长于开放性手术组,住院时间、引流管留置时间、导尿管留置时间、胃肠功能恢复时间短于开放性手术组,术中出血量少于开放性手术组(P<0.05)。腹腔镜手术组患者术后发生肠梗阻1例(3.57%),尿漏3例(10.71%),尿道狭窄6例(21.43%);开放性手术组患者术后发生肠梗阻6例(30.00%),尿漏2例(10.00%),尿道狭窄4例(20.00%);腹腔镜手术组患者术后肠梗阻发生率低于开放性手术组(P<0.05),但2组患者术后尿漏及尿道狭窄发生率比较差异无统计学意义(P>0.05)。腹腔镜手术组患者术后1周及1、3、6个月尿失禁发生率分别为3.57%(1/28)、3.57%(1/28)、0.00%(0/28)、0.00%(0/28),开放性手术组患者术后1周及1、3、6个月尿失禁发生率分别为30.00%(6/20)、25.00%(5/20)、15.00%(3/20)、5.00%(1/20);腹腔镜手术组患者术后1周及1、3个月尿失禁发生率低于开放性手术组(P<0.05),但2组患者术后6个月尿失禁发生率比较差异无统计学意义(P>0.05)。术后6个月,与开放性手术组比较,腹腔镜手术组患者PVR减少,IPSS评分降低,Qmax升高(P<0.05)。腹腔镜手术组患者术后1、2a生化复发率分别为7.14%(2/28)、14.29%(4/28),开放性手术组患者术后1、2a生化复发率分别为10.00%(2/20)、15.00%(3/20);2组患者术后1、2a生化复发率比较差异均无统计学意义(P>0.05)。结论腹腔镜手术治疗早期前列腺癌具有创伤小、术中出血少、术后恢复快、并发症少等优点。

Objective To compare the clinical efficacy and safety of laparoscopic radical prostatectomy and open radical prostatectomy in the treatment of early prostate cancer.Methods Forty-eight patients with early prostate cancer admitted to the First Affiliated Hospital of Xinxiang Medical University from September 2013 to January 2016 were divided into laparoscopic operation group(n=28)and open operation group(n=20).The patients in the open group were performed with open radical prostatectomy,and the patients in the laparoscopic operation group were treated with laparoscopic radical prostatectomy.The operation time,intraoperative bleeding volume,hospitalization time,retention time of drainage tube,retention time of catheter and recovery time of gastrointestinal function of the patients in the two groups were recorded.The complications of the patients were observed.Six months after operation,the postvoid residual(PVR)was measured by B-mode ultrasound,and the maximum urinary flow rate(Qmax)was detected by urodynamic analyzer,and the patients were evaluate by international prostate symptom score(IPSS).All patients were followed up for two years to observe the biochemical recurrence after operation.Results Compared with the open operation group,the operation time was longer,the hospitalization time,retention time of drainage tube,retention time of catheter,recovery time of gastrointestinal function were shorter,and the intraoperative bleeding volume was less in the aparoscopic operation group(P<0.05).There was one case(3.57%)of intestinal obstruction occurred,3 cases(10.71%)of urinary leakage and 6 cases(21.43%)of urethral stricture in the laparoscopic operation group;there were 6 cases(30.00%)of intestinal obstruction,2 cases(10.00%)of urinary leakage and 4 cases(20.00%)of urethral stricture in the open operation group.The incidence of intestinal obstruction in the laparoscopic operation group was lower than that in the open operation group(P<0.05),but there was no significant difference in the incidence of urinary leakage and urethral stricture between the two groups(P>0.05).The incidence of urinary incontinence at 1 week,1,3 and 6 months after operation in the laparoscopic operation group was 3.57%(1/28),3.57%(1/28),0.00%(0/28)and 0.00%(0/28),respectively;and it was 30.00%(6/20),25.00%(5/20),15.00%(3/20)and 5.00%(1/20),respectively in the open operation group.The incidence of urinary incontinence in the laparoscopic operation group was lower than that in the open operation group at 1 week,1 and 3 months after operation(P<0.05),but there was no significant difference in the incidence of urinary incontinence between the two groups at 6 months after operation(P>0.05).Compared with the open operation group,the PVR was fewer,the IPSS score was lower and the Qmax was higher in the laparoscopic operation group at six months after operation(P<0.05).The 1-and 2-year biochemical recurrence rates in laparoscopic operation group were 7.14%(2/28)and 14.29%(4/28),and they were 10.00%(2/20)and 15.00%(3/20)in the open operation group.There was no significant difference in 1-and 2-year biochemical recurrence rate between the two groups(P>0.05).Conclusion Laparoscopic operation for early prostate cancer has the advantages of less trauma,less bleeding,faster recovery and fewer complications.