腹腔镜下寡转移前列腺癌根治术的临床疗效观察

Observation on the clinical efficacy of laparoscopic radical prostatectomy for oligometastatic prostate cancer

目的 探讨前列腺癌寡转移患者行腹腔镜下前列腺癌根治术的临床疗效。方法 选择2018年6月~2020年10月南昌大学附属赣州市人民医院收治的15例寡转移前列腺癌患者,均行腹腔镜下前列腺癌根治术,观察围术期指标及手术并发症。结果 15例患者均成功施行腹腔镜下前列腺癌根治术,无中转开腹。平均手术时间(187.2±30.4)min,平均术中出血量(231.7±20.2)ml,无术中输血。术中发生直肠损伤1例,淋巴漏1例,平均留置尿管时间(14.4±2.1)d,平均住院时间(14.8±2.5)d。术后病理:10例(66.7%)切缘阳性。术后1个月尿失禁发生率86.6%(13/15),术后3个月尿失禁发生率33.3%(5/15)。术后1个月血清前列腺特异性抗原(PSA)水平较术前降低,差异有统计学意义(t=13.199,P<0.05)。中位随访时间21.6个月,随访期间,5例(33.3%)患者于术后出现PSA复发,影像学检查证实局部复发;其中3例进展为去势抵抗性前列腺癌。结论 寡转移前列腺癌患者经严格筛选后行腹腔镜下前列腺癌根治术可行。

Objective To investigate the clinical efficacy of laparoscopic radical prostatectomy in patients with oligometastatic prostate cancer. Methods A total of 15 patients with oligometastatic prostate cancer treated in Ganzhou People’s Hospital Affiliated to Nanchang University from June 2018 to October 2020 were selected and underwent laparoscopic radical prostatectomy. The perioperative indexes and surgical complications were observed. Results Laparoscopic radical prostatectomy was successfully performed in all 15 patients without conversion to laparotomy. The average operation time was(187.2±30.4) min, the average amount of intraoperative bleeding was(231.7±20.2) ml, and there was no intraoperative blood transfusion. There was 1 case of rectal injury and 1 case of lymphatic leakage during the operation, the average indwelling urinary catheter was inserted for(14.4±2.1) days, and the average hospitalization lasted(14.8±2.5) days. In terms of postoperative pathology, 10 cases(66.7%) had positive surgical margins. The incidence of urinary incontinence was 86.6%(13/15) one month after operation and 33.3%(5/15) three months after operation.The level of serum prostate specific antigen(PSA) decreased one month after operation compared with that before operation, with statistically significant differences(t=13.199, P<0.05). The median follow-up time was 21.6 months. During the follow-up period, 5 patients(33.3%) developed PSA recurrence after operation, and imaging examination confirmed local recurrence, of which 3 cases developed castration-resistant prostate cancer. Conclusion Laparoscopic radical prostatectomy is feasible for patients with oligometastatic prostate cancer upon strict screening.