筋膜内与筋膜间保留神经的腹膜外腹腔镜下前列腺癌根治术临床疗效比较

Prospective case-control study of intrafascial versus interfascial nerve-sparing techniques in extraperitoneal laparoscopic radical prostatectomy for prostate cancer

目的比较腹膜外腹腔镜下筋膜内与筋膜间保留神经的前列腺癌根治术治疗前列腺癌的临床疗效。方法回顾性分析嘉应学院医学院附属医院2012年1月至2015年6月期间行保留神经前列腺癌根治术的80例患者的临床资料,其中行筋膜间和筋膜内保留神经前列腺癌根治术治疗者各40例,分别设为筋膜间组和筋膜内组,观察两组患者的手术时间、术中出血量、术后引流时间、住院时间、病理分期、切缘阳性率,以及术后3个月时前列腺特异性抗原(PSA)水平,术后3个月、6个月时患者勃起功能和控尿功能。结果两组患者的手术时间、术中出血量、术后引流时间及住院时间、术后3个月时PSA水平、病理分期比较差异均无统计学意义(P>0.05);切缘阳性率筋膜间组为15.00%,筋膜内组为10.00%,差异无统计学意义(P>0.05);术后3个月、术后6个月时,勃起功能正常率筋膜间组为25.00%、44.44%,低于筋膜内组的47.50%、67.57%,控尿功能正常率筋膜间组为57.50%、72.22%,低于筋膜内组的80.00%、91.89%,两组比较差异均有统计学意义(P<0.05)。结论腹膜外腹腔镜下筋膜内与筋膜间保留神经前列腺癌根治术治疗术前勃起功能正常的早期局限性前列腺癌,疗效相当,但筋膜内保留神经前列腺癌根治术在术后勃起功能及控尿功能恢复方面优于筋膜间手术。

Objective To compare the clinical efficacy of intrafascial and interfascial nerve-sparing techniques in extraperitoneal laparoscopic radical prostatectomy for prostate cancer. Methods The clinical data of 80 patients,who underwent radical prostatectomy for prostate cancer from January 2012 to June 2015 in the Affiliated Hospital of Medical College of Jiaying University, were retrospectively analyzed. Forty cases underwent intrafascial nerve-sparing technique(intrafascial nerve-sparing group), and 40 cases underwent interfascial nerve-sparing technique(interfascial nerve-sparing group). The operation time, intraoperative blood loss, postoperative drainage time, hospitalization time,postoperative pathologic staging, positive rate of resection margin, the level of prostate specific antigen(PSA) at 3months after operation, erectile function and urinary continence function at 3 months and 6 months after operation were observed. Results There was no significant difference in the operation time, intraoperative blood loss, postoperative drainage time, hospitalization time, postoperative pathologic staging and the level of prostate specific antigen(PSA) at3 months after operation between the two groups(P>0.05); the positive rate of resection margin of the interfascial nerve-sparing group and the intrafascial nerve-sparing group were 15.00% and 10.00%, respectively, and the difference was not statistically significant(P>0.05); the erectile function and urinary continence function at 3 months and 6months after operation in the interfascial nerve-sparing group were 25.00%, 44.44%, 57.50% and 72.22%, respectively,which were significantly lower than 47.50%, 67.57%, 80.00% and 91.89% in the intrafascial nerve-sparing group(P<0.05). Conclusion The clinical efficacy of bilateral intrafascial and interfascial nerve-sparing techniques in extraperitoneal laparoscopic radical prostatectomy for prostate cancer are almost the same, while intrafascial nerve-sparing techniques is superior to interfascial nerve-sparing techniques in postoperative erectile function and urinary function recovery.