不同手术入路前列腺切除术对前列腺癌的疗效及术后复发影响因素分析

Therapeutic effect of prostatectomy by different approach on prostate cancer and influencing factors for postoperative recurrence analysis

目的探讨不同手术入路根治性前列腺切除术(RP)对局限性前列腺癌(PCa)的疗效,并分析术后生化复发(BCR)的影响因素。方法选取2017年8月至2019年8月温州医科大学附属第一医院收治的108例采用RP治疗的PCa患者作为研究对象。根据入路方式的不同分为经腹腹腔镜前列腺根治术(TLRP)组(n=56)和经腹膜外腹腔镜前列腺根治术(ELRP)组(n=52)。比较两组的围手术期指标、术后并发症、控尿情况和BCR情况,分析术后BCR的影响因素。结果ELRP组的手术时间、卧床时间均显著短于TLRP组(P<0.05);两组术后并发症发生率比较,差异无统计学意义(P>0.05);两组术后6个月、1年的完全控尿率和术后1年、2年的BCR率比较,差异无统计学意义(P>0.05);Cox回归分析结果显示,体重指数(BMI)≥25kg/m^(2)、病理分期>pT2、前列腺特异性抗原(PSA)水平≥14ng/mL、Gleason评分≥6分均是BCR的独立危险因素(P<0.05)。结论经腹膜外入路与经腹腔入路疗效及安全性相当,且腹膜外入路利于缩短手术时间和恢复。高BMI、病理分期、Gleason评分和PSA水平均是BCR的危险因素。

Objective To explore the therapeutic effect of radical prostatectomy(RP)on prostate cancer(PCa)and analyze influencing factors of postoperative biochemical recurrence(BCR).Methods 108 PCa patients treatea with RP in the First Affiliated Hospital of Wenzhou Medical University from August 2017 to August 2019 were selected as the research objects.According to different approaches,they were divided into transperitoneal laparoscopic radical prostatectomy(TLRP)group(n=56)and extraperitoneal laparoscopic radical prostatectomy(ELRP)group(n=52).Perioperative indicators,postoperative complications,urinary continence and BCR were compared between two groups,the influencing factors on postoperative BCR were analyzed.Results Operative time and length of bed confinement were significantly shorter in the ELRP group than the TLRP group(P<0.05).There were no significant differences in the postoperative complications rates between two groups(P>0.05).There were no significant difference between the two groups in the rate of complete urination 6 months and 1 year after operation and the rate of BCR 1 and 2 years after operation(P>0.05).Cox regression model showed that body mass index(BMI)≥25 kg/m^(2),pathological stage>pT2,prostate specific antigen(PSA)≥14 ng/mL and Gleason grade≥6 were independent dangerous factors for BCR(P<0.05).Conclusions The efficacy and safety of extraperitoneal approach is similar to that of transperitoneal approach,and extraperitoneal approach is beneficial to shorten the operation time and recovery.High BMI,pathological stage,Gleason score and PSA level were the risk factors for BCR.