三孔法经腹膜外腹腔镜下根治性前列腺切除术治疗局限性前列腺癌效果分析

Retrospective study of three-hole extraperitoneal laparoscopic radical prostatectomy for localized prostate cancer

目的探讨三孔法经腹膜外腹腔镜下根治性前列腺切除术(ELRP)治疗局限性前列腺癌的效果。方法回顾性分析新乡医学院第三附属医院泌尿外科2018-01—2019-06行ELRP治疗的93例局限性前列腺癌患者的临床资料。采用三孔法ELRP治疗的(49例)为观察组,采用四孔法ELRP治疗的44例为对照组。对比2组围术期指标、术前、术后1 d、术后3 d血清应激反应指标肾上腺素(E)、去甲肾上腺素(NE)、皮质醇(Cor)、血糖(Glu),胰岛素样生长因子1(IGF-1),游离前列腺特异性抗原(fPSA)水平及术后12个月尿失禁发生率、生化复发率。结果观察组手术时间短于对照组,术中出血量低于对照组,差异有统计学意义(P<0.05);2组术后Gleason评分、术后尿管留置时间、住院时间差异无统计学意义(P>0.05);术后1 d、术后3 d 2组血清E、NE、Cor、Glu水平高于术前,但观察组低于对照组,差异有统计学意义(P<0.05);术后1 d、术后3 d 2组血清fPSA、IGF-1水平低于术前,差异有统计学意义(P<0.05),2组间对比差异无统计学意义(P>0.05);2组术后12个月尿失禁发生率、生化复发率比较,差异无统计学意义(P>0.05)。结论三孔法、四孔法ELRP治疗局限性前列腺癌患者效果相当,但三孔法具有创伤小、手术时间短、出血少、应激反应轻等优势。

Objective To investigate the effect of three-hole extraperitoneal laparoscopic radical prostatectomy(ELRP)in the treatment of localized prostate cancer.Methods The clinical data of 93 patients with localized prostate cancer in our hospital from January 2018 to June 2019 were retrospectively analyzed.49 patients treated with three-well ELRP were selected as the observation group,and 44 patients treated with four-well ELRP were selected as the control group.Compared two groups perioperative indicators,preoperative and postoperative 1 d,3 d postoperative serum stress reaction index[epinephrine(E)and norepinephrine(NE)and cortisol(Cor),glucose(Glu)],insulin-like growth factor 1(IGF 1),free prostate specific antigen(fPSA)levels and the incidence of urinary incontinence after 12 months,biochemical recurrence rate.Results The operation time of the observation group was shorter than that of the control group,and the intraoperative blood loss was lower than that of the control group(P<0.05).There were no significant difference in postoperative Gleason score,postoperative catheter indwelling time and length of hospital stay between the two groups(P>0.05).The serum levels of E,NE,Cor and Glu in two groups were higher than those before surgery,but the observation group was lower than that of the control group(P<0.05).The serum levels of FPSA and IGF-1 in the two groups were lower than those before surgery 1 and 3 days after surgery(P<0.05),but there was no significant difference between the two groups(P>0.05).There were no significant difference in the incidence of urinary incontinence and biochemical recurrence rate between the two groups 12 months after operation(P>0.05).Conclusion Three-well ELRP and four-well ELRP have the same effect in the treatment of localized prostate cancer,but the three-well ELRP has the advantages of less trauma,shorter operation time,less bleeding and less stress reaction.