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目的:回顾分析329例经腹膜外腹腔镜前列腺癌根治术的手术方法和疗效。方法:2005年3月～2010年3月经腹膜外腹腔镜前列腺癌根治术329例,中位年龄67岁,初始前列腺特异性抗原中位数为17.35μg/L,活检Gleason评分中位数为7。结果:329例手术均成功完成,无中转开放手术。膀胱尿道吻合时间中位数为13min,手术时间中位数为90min,术中失血量中位数为75ml,术后尿管留置时间中位数为6d。整体切缘阳性率为16.7%,与病理分期和Gleason评分具有相关性(P<0.001)。术后1年内,年轻患者的尿控能力恢复较快,而且性功能恢复较好。术后随访时间中位数为27(14～72)个月,89例出现生化复发;多因素分析显示初始PSA值、切缘阳性率、病理分期和Gleason评分是无生化复发生存的独立预后因素。术前新辅助激素治疗对病理Gl-eason评分(P<0.001)和手术切缘阳性率(P=0.027)有显著影响,但对生化复发没有显著影响(P=0.202)。结论:经腹膜外腹腔镜前列腺癌根治术是局限性前列腺癌安全有效的微创外科治疗方法,值得临床推广。
Objective: To retrospectively analyze the operation and efficacy of 329 cases of radical prostatectomy by extraperitoneal laparoscopic radical prostatectomy. Methods: From March 2005 to March 2010, 329 patients underwent radical extraperitoneal laparoscopic radical prostatectomy with a median age of 67 years. The median initial prostatic specific antigen was 17.35 μg / L. The median Gleason score of biopsy was 7 . Results: All the 329 surgeries were completed successfully. There was no transfer to open surgery. The median duration of anastomosis of bladder and urethra was 13 min, the median time of operation was 90 min, the median blood loss during operation was 75 mL, and the median postoperative catheterization time was 6 days. The overall positive rate of margins was 16.7%, which was correlated with pathological stage and Gleason score (P <0.001). Within 1 year after surgery, young patients with urinary control ability to recover faster, and better recovery of sexual function. The median follow-up time was 27 (14-72) months and 89 patients had biochemical recurrence. Multivariate analysis showed that the initial PSA value, positive margins, pathological staging and Gleason score were independent prognostic factors for survival without biochemical recurrence . Preoperative neoadjuvant hormone therapy had significant effects on pathological Gl-eason score (P <0.001) and surgical margin positive (P = 0.027), but had no significant effect on biochemical recurrence (P = 0.202). Conclusions: Extraperitoneal laparoscopic radical prostatectomy is a safe and effective minimally invasive surgical treatment of localized prostate cancer, which is worthy of clinical promotion.