3D与2D腹腔镜前列腺癌根治术治疗前列腺癌的临床疗效比较

Comparison of the clinical effects of 3D and 2D laparoscopic radical prostatectomy for prostate cancer

目的比较3D与2D腹腔镜前列腺癌根治术(LRP)治疗前列腺癌的临床疗效。方法纳入2017年7月至2019年7月海南医学院第二附属医院泌尿外科收治的124例前列腺癌患者,按照手术方式不同分组,3D-LRP组37例患者行3D腹腔镜前列腺癌根治术,2D-LRP组87例行2D腹腔镜前列腺癌根治术。采用统计软件SPSS 21.0进行数据分析,观察比较两组围术期指标、并发症及术后随访结果等临床指标。结果(1)3D-LRP组在手术时间、术中出血量、尿道重建时间、留置尿管时间、住院天数时间方面优于2D-LRP组患者,差异具有统计学意义(P<0.05);术中保留性神经和切缘阳性率方面3D-LRP组低于2D-LRP组,但差异无统计学意义(P>0.05)。(2)两组患者术后吻合口瘘、尿道狭窄、淋巴漏发生率比较差异无统计学意义(P>0.05);拔除尿管后3D-LRP组患者尿失禁发生率低于2D-LRP组,差异有统计学意义(P<0.05)。(3)3D-LRP组术后12个月时勃起功能障碍明显少于2D-LRP组,差异有统计意义(P<0.05)。(4)3D-LRP组在拔出导尿管后1个月、3个月、6个月、12个月尿控恢复情况均优于2D-LRP组,但差异无统计学意义(P>0.05);3D-LRP组术后3个月PCa生化复发1例,2D-LRP组复发3例,两组比较差异无统计学意义(P>0.05)。结论3D-LRP较2D-LRP手术效果好,术后恢复快、并发症发生率低,但近期疗效上未见明显影响,值得推广。

Objective To compare the clinical efficacy of 3 D-LRP and 2 D-LRP laparoscopic radical prostatectomy(LRP)for prostate cancer.Methods 124 patients with prostate cancer admitted to the urology department of Second Affiliated Hospital of Hainan Medical College from July 2017 to July 2019 were included.According to different surgical methods,37 patients in the 3 D-LRP group underwent 3 D-LRP,while 87 patients in the 2 D-LRP group underwent 2 D-LRP.Statistical software SPSS 21.0 was used for data analysis to compare the perioperative indicators,complications,postoperative follow-up results and other clinical indicators of the two groups.Results(1)The 3 D-LRP group was superior to the 2 D-LRP group in terms of operation time,intraoperative blood loss,urethral reconstruction time,indwelling catheter time,and length of hospital stay,with statistically significant differences(P<0.05).The positive rate of intraoperative reserved nerve and resection margin was lower in the 3 D-LRP group than in the 2 D-LRP group,but the difference was not statistically significant(P>0.05).(2)The incidence of anastomotic leakage,urethral stricture,and lymphatic leakage between the two groups were not statistically different(P>0.05);The incidence of urinary incontinence in the 3 D-LRP group was lower than that in the 2 D-LRP group after catheter removal,and the difference was statistically significant(P<0.05).(3)The erectile dysfunction in the 3 D-LRP group was significantly less than that in the 2 D-LRP group at 12 months after surgery,and the difference was statistically significant(P<0.05).(4)The recovery of urinary control in the 3 D-LRP group at 1 month,3 months,6 months,and 12 months after the catheter was removed was better than that of the 2 D-LRP group,but there were no statistical difference(P>0.05);There was 1 case of PCa recurrence in 3 D-LRP group and 3 cases of recurrence in 2 D-LRP group 3 months after operation,and there was no significant difference between the two groups(P>0.05).Conclusion Compared with 2 D-LRP,3 D-LRP has a better effect,faster postoperative recovery and lower incidence of complications,but no significant effect has been observed in the short-term efficacy,so it is worthy of promotion.