三孔法与五孔法经腹膜外入路腹腔镜前列腺癌根治术的比较

Comparison of three-port and five-port extra-peritoneal laparoscopic radical prostatectomy

目的探讨三孔法与五孔法经腹膜外入路腹腔镜前列腺癌根治术(ELRP)的临床效果。方法回顾分析柳州市人民医院泌尿外科2013年6月至2019年3月收治的90例行ELRP的患者资料,其中观察组行三孔法ELRP 48例,对照组行五孔法ELRP 42例。比较两组患者的一般资料、围手术期结果、并发症、尿控恢复情况和肿瘤结局指标。结果全部90例前列腺癌患者均在腹腔镜下顺利完成手术,无中转开放手术。两组患者在年龄、体质量指数、Gleason评分、术前PSA、临床分期方面差异无统计学意义(P>0.05)。观察组手术时间、术中出血量、前列腺体积均少于对照组,差异均有统计学意义(P<0.05);两组术后留置引流管时间、留置导尿时间、住院时间和术后漏尿、尿道狭窄、尿失禁发生率比较,差异均无统计学意义(P>0.05);两组术后尿控率相似,差异无统计学意义(P>0.05);两组术后切缘阳性分别为2例和8例,差异有统计学意义(P<0.05);观察组术后随访6~36个月,平均12个月,对照组术后随访6~48个月,平均17个月,两组生化复发分别为1例和2例,差异无统计学意义(P>0.05)。结论与五孔法ELRP相比,三孔法ELRP治疗前列腺癌创伤小、具有相似疗效,且未增加并发症,值得临床推广。

Objective To investigate the clinical efficacy of three-port and five-port extrasperitoneal laparoscopic radical prostatectomy(ELRP).Methods The clinical data of 90 patients who were admitted to our department from June 2013 to March 2019 and underwent ELRP were retrospectively analyzed.Among them,48 cases in the observation group underwent three-port ELRP and 42 cases in the control group underwent five-port ELRP.The general data,perioperative outcomes,complications,urinary control recovery and tumor outcome were compared between the 2 groups.Results All the 90 patients underwent laparoscopic surgery successfully without turning to open surgery.There were no significant differences including age,body mass index,Gleason scores,PSA and clinical stage between the 2 groups(P>0.05).The operative time,estimated blood loss and prostate volume of the observation group were all less than those of the control group(P<0.05).There were no significant statistical differences of drainage tube keeping days,indwelling catheter time,hospital stay and the incidence of urinary leakage,urethral stricture and urinary incontinence between the 2 groups(P>0.05).The rates of urinary control of the two groups were similar(P>0.05).Positive surgical margin of the two groups were 2 cases and 8 cases respectively(P<0.05).Patients in the observation group were followed up for 6 to 36 months after surgery,with an average of 12 months,while patients in the control group were followed up for 6 to 48 months after surgery,with an average of 17 months,biochemical recurrence were 1 case and 2 cases respectively(P>0.05).Conclusion Compared to five-port ELRP,three-port ELRP has less trauma,similar efficacy and no increased complications,which is worthy of clinical promotion.