摘要
目的探讨腹腔镜顺行双保前列腺癌根治术(LabNSRP)对前列腺癌患者应激激素、尿动力学及术后并发症的影响。方法选取2021年3月至2024年2月新乡医学院第一附属医院收治的80例前列腺癌患者纳入研究,采用随机数表法分为对照组和观察组各40例,对照组患者行腹腔镜前列腺癌根治术(LRP),观察组患者行LabNSRP。比较两组患者的围术期指标,术前及术后24 h、72 h的血清应激激素[促生长激素(GH)、促肾上腺皮质激素(ACTH)、皮质醇(Cor)]水平,术前及术后3个月的性激素水平[二氢睾固酮(DHT)、促黄体生成素(LH)、游离睾酮(FT)、促卵泡激素(FSH)],尿动力学指标(尿道闭合压、膀胱容量、尿流率、残余尿量),勃起功能评分(IIEF-5)及前列腺癌治疗与功能评价生活质量量表(FACT-P)评分,统计两组患者术后并发症发生率。结果观察组患者的手术时间、术后拔管及住院时间分别为(135.78±18.77)min、(6.52±1.49)d、(9.27±1.09)d,明显短于对照组的(146.12±25.69)min、(7.34±2.05)d、(10.74±2.18)d,差异均有统计学意义(P<0.05),但两组患者的术中出血量、术后引流量及肠功能恢复时间比较差异均无统计学意义(P>0.05)。观察组患者术后24 h、72 h的血清GH、ACTH、Cor水平明显低于对照组,差异均有统计学意义(P<0.05)。术后3个月,观察组患者的LH、FSH、DHT及FT水平分别为(7.14±0.75)U/L、(10.27±1.25)U/L、(592.84±48.96)ng/L、(0.37±0.07)nmol/L,明显高于对照组的(6.58±0.67)U/L、(8.94±1.17)U/L、(557.49±45.26)ng/L、(0.32±0.06)nmol/L,差异均有统计学意义(P<0.05)。术后3个月,观察组患者的尿流率、尿道闭合压、膀胱容量分别为(18.24±1.37)mL/s、(72.39±4.28)cm H_(2)O、(349.84±18.25)mL,明显高(多)于对照组的(15.42±1.22)mL/s、(69.25±4.13)cm H_(2)O、(332.14±15.13)mL,残余尿量为(25.24±3.02)mL,明显少于对照组的(31.29±3.98)mL,差异均有统计学意义(P<0.05);术后3个月,观察组患者的IIEF-5及FACT-P评分分别为(21.27±1.63)分、(118.47±10.25)分,明显高于对照组的(18.94±1.57)分、(102.37±14.87)分,差异均有统计学意义(P<0.05)。观察组患者术后并发症总发生率为5.00%,明显低于对照组的22.50%,差异有统计学意义(P<0.05)。结论LabNSRP治疗前列腺癌创伤小、手术效率高,可保护患者性功能和尿控功能,提高生活质量。
Objective To investigate the impact of laparoscopic antegrade bilateral nerve-sparing radical pros-tatectomy(LabNSRP)on stress hormones,urodynamics,and postoperative complication rates in patients with prostate cancer.Methods Eighty patients with prostate cancer admitted to the First Affiliated Hospital of Xinxiang Medical Uni-versity from March 2021 to February 2024 were enrolled and randomly assigned to a control group(n=40)and an obser-vation group(n=40)using a random number table method.Patients in the control group underwent laparoscopic radical prostatectomy(LRP),while those in the observation group underwent LabNSRP.Perioperative indicators,as well as pre-operative and postoperative 24-hour and 72-hour serum stress hormone levels(growth hormone[GH],adrenocorticotrop-ic hormone[ACTH],cortisol[Cor]),preoperative and postoperative 3-month sex hormone levels(dihydrotestosterone[DHT],luteinizing hormone[LH],free testosterone[FT],follicle-stimulating hormone[FSH]),urodynamic indicators(urethral closure pressure,bladder capacity,urinary flow rate,residual urine volume),erectile function score(IIEF-5),and Functional Assessment of Cancer Therapy-Prostate(FACT-P)scores were compared between the two groups.The in-cidence of postoperative complications was also statistically analyzed.Results The operation duration,postoperative extubation duration,and hospital stay of patients in the observation group were(135.78±18.77)min,(6.52±1.49)d,and(9.27±1.09)d,respectively,which were significantly shorter than corresponding(146.12±25.69)min,(7.34±2.05)d,and(10.74±2.18)d in the control group,with statistically significant differences(all P<0.05).However,there were no statisti-cally significant differences in intraoperative blood loss,postoperative drainage volume,and intestinal function recovery time between the two groups(all P>0.05).At 24 h and 72 h postoperatively,the levels of serum GH,ACTH,and Cor were significantly lower in the observation group than in the control group(all P<0.05).Three months after surgery,the levels of LH,FSH,DHT,and FT in patients in the observation group were(7.14±0.75)U/L,(10.27±1.25)U/L,(592.84±48.96)ng/L,and(0.37±0.07)nmol/L,respectively,which were significantly higher than corresponding(6.58±0.67)U/L,(8.94±1.17)U/L,(557.49±45.26)ng/L,and(0.32±0.06)nmol/L in the control group,with statistically significant differ-ences(all P<0.05).Three months after surgery,the urinary flow rate,urethral closure pressure,and bladder capacity of the observation group were(18.24±1.37)mL/s,(72.39±4.28)cmH2O,and(349.84±18.25)mL,respectively,which were significantly higher(or greater)than the control group's(15.42±1.22)mL/s,(69.25±4.13)cmH_(2)O,and(332.14±15.13)mL of the control group(all P<0.05);the residual urine volume was(25.24±3.02)mL,which was significantly lower than(31.29±3.98)mL in the control group(P<0.05).Three months after surgery,the IIEF-5 and FACT-P scores of patients in the observation group were(21.27±1.63)points and(118.47±10.25)points,respectively,which were significantly higher than the corresponding(18.94±1.57)points and(102.37±14.87)points of the control group(both P<0.05).The overall in-cidence of postoperative complications was 5.00%in the observation group versus 22.50%in the control group(P<0.05).Conclusion LabNSRP offers minimal trauma and high surgical efficiency in the treatment of prostate cancer,while protecting patients'sexual function and urinary control,and improving their quality of life.
作者
韩广业
马阔
宋伟航
刘沛
张少华
范毛川
HAN Guang-ye;MA Kuo;SONG Wei-hang;LIU Pei;ZHANG Shao-hua;FAN Mao-chuan(Department of Urology,the First Affiliated Hospital of Xinxiang Medical University,Xinxiang 453100,Henan,CHINA)
出处
《海南医学》
2025年第13期1879-1884,共6页
Hainan Medical Journal
基金
2022年度河南省医学科技攻关计划联合共建项目(编号:LHGJ20220607)
2024年度河南省医学科技攻关计划联合共建项目(编号:LHGJ20240488)。
关键词
前列腺癌
腹腔镜顺行双保前列腺癌根治术
性功能
生活质量
并发症
Prostate cancer
Laparoscopic antegrade bilateral nerve-sparing radical prostatectomy
Sexual func-tion
Quality of life
Complication
