腹腔镜下根治性前列腺切除术联合新辅助内分泌治疗T3N0M0期前列腺癌的临床效果

Clinical effect of laparoscopic radical prostatectomy combined with neoadjuvant hormonal therapy for T3N0M0 prostate cancer

目的探讨腹腔镜下根治性前列腺切除术联合新辅助内分泌治疗(NHI)T3N0M0期前列腺癌的临床效果。方法回顾性分析2010年1月—2019年7月福建省立医院及福建省立金山医院泌尿外科收治的72例T3N0M0期前列腺腺癌患者的临床资料,按照有无采用NHT分为实验组(38例)及对照组(34例)。实验组采用腹腔镜下根治性前列腺切除术联合NHT治疗方案。对照组采用腹腔镜下根治性前列腺切除术治疗。比较两组的手术时间、术中出血量、术后切缘阳性例数、术后血清前列腺特异性抗原(PSA)水平、直肠损伤例数、尿失禁例数、吻合口尿瘘例数、勃起功能障碍例数等资料。结果两组的手术时间比较,差异无统计学意义(P>0.05);两组的术中出血量比较,差异无统计学意义(P>0.05);实验组的切缘阳性例数少于对照组,差异有统计学意义(P<0.05)。术后1年,实验组的血清PSA水平低于对照组,差异有统计学意义(P<0.05);两组的直肠损伤、尿失禁、尿瘘、勃起功能障碍例数比较,差异无统计学意义(P>0.05)。结论腹腔镜下根治性前列腺切除术联合NHT治疗T3N0M0期前列腺癌安全有效,能够降低手术切缘阳性率,对手术难度及术后并发症的发生无影响,值得临床推广。

Objective To explore the clinical effect of laparoscopic radical prostatectomy combined with neoadjuvant hormonal therapy(NHT)for T3N0M0 prostate cancer.Methods The clinical data of 72 patients with T3N0M0 stage prostate adenocarcinoma admitted to Urology of Fujian Provincial Hospital and Fujian Provincial Jinshan Hospital from January 2010 to July 2019 were retrospectively analyzed.They were divided into the experimental group(38 cases)and the control group(34 cases)according to whether NHT was used.The experimental group were treated by laparoscopic radical prostatectomy combined with NHT.The control group were treated by laparoscopic radical prostatectomy.The operation time,intraoperative blood loss,serum prostate specific antige(PSA)level,postoperative incision margin positive,rectal injury,urinary incontinence,anastomotic leakage and erectile dysfunction were compared between the two groups.Results There was no significant difference in the operation time between the two groups(P>0.05).There was no significant difference in the amount of bleeding between the two groups(P>0.05).The number of positive cases in the experimental group was less than that in the control group,the difference was statistically significant(P<0.05).The serum PSA level in the experimental group was lower than that in the control group,the difference was statistically significant(P<0.05).There were no significant differences in the number of rectal injury,urinary incontinence,urinary fistula and erectile dysfunction between the two groups(P>0.05).Conclusion Laparoscopic radical prostatectomy combined with NHT in the treatment of T3N0M0 stage prostate cancer is safe and effective,which could significantly reduce the positive rate of surgical margin,and have no effect on the operation difficulty and postoperative complications,which is worthy of clinical promotion.