摘要
目的探究改良经腹膜外全筋膜内腹腔镜前列腺癌根治性切除对局限性前列腺癌的临床疗效。方法选取110例局限性前列腺癌患者,按照随机数字表法分为对照组和观察组,每组55例。2组均行经腹膜外腹腔镜前列腺癌根治性切除术,对照组术中采取常规筋膜间保留血管神经束,观察组术中采取改良全筋膜内切除。比较2组手术情况、切缘阳性率、血管内皮生长因子(VEGF)、胰岛素样生长因子I(IGF-I)、充盈期膀胱顺应性值(BC)、残余尿量(PVR)、最大尿流率(Qmax)、最大尿流率状态下逼尿肌压力(Pdetat Qmax)、控尿率、勃起功能正常率及并发症发生率。术后随访1年,对比2组生化复发率。结果2组手术时间、术中出血量、术后尿管及引流管留置时间、住院时间、切缘阳性率比较,差异无统计学意义(P>0.05);且2组均无中转开腹,术中、术后均无输血。观察组术后3 d、术后7 d血清VEGF、IGF-I水平低于对照组(P<0.05);观察组术后1个月、术后3个月、术后6个月BC、PVR低于对照组(P<0.05),Qmax、Pdetat Qmax高于对照组(P<0.05);观察组术后1个月、术后3个月控尿率、勃起功能正常率高于对照组(P<0.05),并发症发生率低于对照组(P<0.05);观察组术后1年生化复发率与对照组比较,差异无统计学意义(P>0.05)。结论改良经腹膜外全筋膜内腹腔镜前列腺癌根治性切除治疗局限性前列腺癌的临床效果良好,手术操作对血管内皮刺激较轻,术后尿流动力学、控尿与勃起功能恢复较快,并发症发生率较低,且不会增加切缘阳性及生化复发风险。
Objective To explore the clinical efficacy of modified extraperitoneal total intrafascial laparoscopic radical prostatectomy for localized prostate cancer.Methods A total of 110 patients with localized prostate cancer were selected and divided into the control group and the observation group according to the random number table method,with 55 patients in each group.Both of the two groups underwent extraperitoneal laparoscopic radical prostatectomy.In the control group,the interfascial vascular and nerve bundles were routinely retained,while the observation group underwent modified total intrafascial excision during the operation.The operation conditions,positive incisal margin rate,vascular endothelial growth factor(VEGF),insulin-like growth factor-I(IGF-I),bladder compliance(BC),postvoid residual(PVR),maximum flow rate(Qmax)and detrusor pressure at maximum flow rate(Pdetat Qmax),urinary continece rate,normal erectile function rate and incidence of complications were compared between the two groups.Patients in the two groups were followed up for 1 year and the biochemical recurrence rate was compared.Results There was no significant difference in the operation time,intraoperative bleeding,postoperative urinary catheter and drainage tube retention time,hospitalization time,or positive incisal margin rate between the two groups(P>0.05).There was no patient converted to open surgery,and there was no intraoperative and postoperative blood transfusion in both groups.The serum levels of VEGF and IGF-I in the observation group were lower than those in the control group 3 days and 7 days after surgery(P<0.05).The BC and PVR in the observation group were lower than those in the control group(P<0.05),while the Qmax and Pdetat Qmax were higher than those in the control group(P<0.05)1 month,3 months,and 6 months after surgery.The urinary continece rate and the normal erectile function rate in the observation group were higher than those in the control group(P<0.05)1 month and 3 months after surgery,and the incidence of complications in the observation group was lower than that in the control group(P<0.05).There was no significant difference in the biochemical recurrence rate 1 year after surgery between the two groups(P>0.05).Conclusion Modified extraperitoneal total intrafascial laparoscopic radical prostatectomy for localized prostate cancer has good clinical effect,and it has slighter vascular endothelial irritation from the surgical operation,faster recovery of urodynamics,urinary continece and erectile function after surgery,and lower incidence of complication,without increasing the risk of positive incisal margin and biochemical recurrence.
作者
刘吉文
赵友光
姬生军
王宗勇
LIU Ji-wen;ZHAO You-guang;JI Sheng-jun;WANG Zong-yong(Department of Urology Surgery,Western Theater General Hospital,Chengdu Sichuan 610083,China;Department of Urology Surgery,Affiliated Hospital of Chengdu University,Chengdu Sichuan 610000,China)
出处
《局解手术学杂志》
2022年第12期1057-1061,共5页
Journal of Regional Anatomy and Operative Surgery
基金
成都医学科科研课题(2018055)。
