腹膜外途径腹腔镜下根治性前列腺切除术切缘阳性的影响因素分析

Analysis of influencing factors of positive margin in extraperitoneal laparoscopic radical prostatectomy

目的分析腹膜外途径腹腔镜下根治性前列腺切除术(LRP)切缘阳性的影响因素。方法选择2017年7月~2020年8月在我院接受经腹膜外途径腹腔镜下LRP的252例前列腺癌患者,收集患者临床资料,根据术后切缘病理结果分为阳性组和阴性组,比较两组患者临床指标[年龄、体质指数、前列腺体积、盆腔手术史、临床T分期、前列腺癌危险分度、术前前列腺特异性抗原(PSA)水平]、穿刺指标(穿刺Gleason评分、穿刺阳性针数百分比)、手术指标(穿刺至手术时间、术中出血量、手术时间)、病理指标(术后Gleason评分、术后病理分期),采用Logistic回归分析切缘阳性的独立危险因素。结果252例患者中,术后切缘阳性64例(25.39%),纳入阳性组,切缘阴性188例(74.61%),纳入阴性组。两组患者年龄、体质指数、前列腺体积、盆腔手术史、前列腺癌危险分度、穿刺至手术时间、术中出血量、手术时间差异均无统计学意义(P>0.05),术前PSA水平、临床T分期、穿刺Gleason评分、穿刺阳性针数百分比、术后Gleason评分、术后病理分期差异均有统计学意义(P<0.05);多因素Logistic回归分析显示,术前高PSA水平、高穿刺阳性针数百分比、术后高Gleason评分、术后高级别病理分期是术后切缘阳性的独立危险因素(P<0.05)。结论术前PSA>20ng/ml,穿刺阳性针数百分比>33%,术后Gleason评分≥8分及术后病理分期≥pT3a的患者,经腹膜外途径腹腔镜下LRP术后切缘阳性发生率显著增加。

Objective To analyze the influencing factors of positive margin in laparoscopic radical prostatectomy(LRP)via extraperitoneal approach.Methods A total of 252 patients with prostate cancer who underwent LRP via extraperitoneal approach in our hospital from Jul 2017 to Aug 2020 were enrolled for the study.The clinical data of the patients were collected,and the patients were divided into positive group and negative group according to the postoperative margin pathological results.The clinical indicators(age,body mass index,prostate volume,pelvic surgery history,clinical T staging,prostate cancer risk scale,preoperative PSA level),puncture indicators(puncture Gleason score,percentage of positive puncture needles),surgical indexes(time from puncture to surgery,intraoperative blood loss,surgical time)and pathological indexes(postoperative Gleason score,postoperative pathological staging)were compared between the two groups,and Logistic regression analysis was used to analyze independent risk factors of positive margins.Results Among 252 patients,64 cases(25.39%)with positive margins were included in positive group,and 188 cases(74.61%)with negative margins were included in negative group.There was no significant difference in the age,body mass index,prostate volume,pelvic surgery history,prostate cancer risk scale,time from puncture to surgery,intraoperative blood loss and surgical time between the two groups(P>0.05).However there were statistically significant differences in the preoperative PSA level,clinical T stage,puncture Gleason score,percentage of puncture positive needles,postoperative Gleason score and postoperative pathological staging between the two groups(P<0.05).Multivariate Logistic regression analysis showed that high preoperative PSA level,high percentage of positive puncture needles,high postoperative Gleason score and high-grade postoperative pathological staging were independent risk factors affecting the postoperative positive margins(P<0.05).Conclusion In patients with preoperative PSA>20 ng/ml,percentage of positive puncture needles>33%,postoperative Gleason score≥8 points and postoperative pathological stage≥p T3 a,the incidence rate of positive margins increases significantly after laparoscopic LRP via extraperitoneal approach.