LRP手术对前列腺癌患者的治疗效果及对患者血清miR-146a、PSA、PSMA水平的影响
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摘要
目的探讨腹腔镜下根治性前列腺癌切除术(LRP)治疗前列腺癌的临床效果及对患者血清miR-146a、前列腺癌特异性抗原(PSA)、前列腺特异性膜抗原(PSMA)水平的影响。方法选取我院2013年10月-2015年12月手术治疗的120例前列腺癌患者,根据手术方法分为LRP组(采用腹腔镜下根治性前列腺癌切除术治疗)60例、RRP组(采用开放式耻骨后根治性前列腺癌切除术)60例,对比两组患者的手术时间、手术出血量、导尿管留置时间、住院时间、切缘阳性率、1年尿控率、手术前后血清miR-146a、PSA、PSMA水平的差异。结果 LRP组患者的手术时间长于RRP组(P<0.05),LRP组患者的出血量、导尿管留置时间、住院时间均低于RRP组(P<0.05),两组患者的切缘阳性率差异不具有统计学意义(P>0.05),LRP组患者的1年尿控率(91.67%)高于RRP组(76.67%)(P<0.05);术前,LRP组和RRP组患者的miR-146a、PSA、PSMA水平差异不具有统计学意义(P>0.05);术后3个月,两组患者的血清miR-146a、PSA、PSMA水平较同组术前均显著降低(P<0.05);术后3个月,两组患者的血清miR-146a、PSA、PSMA水平差异不具有统计学意义(P>0.05);LRP组患者的勃起功能障碍率、泌尿系统感染率、切口感染率均显著低于RRP组(P<0.05)。结论LRP治疗前列腺癌的临床效果与RRP手术相当,均能显著降低血清miR-146a、PSA、PSMA水平,且具有手术创伤小、术后尿控率高、并发症少的优势。
Objective To investigate the clinical effect of laparoscopic radical prostatectomy( LRP) against prostate cancer and its effect on serum miR-146 a,prostate cancer specific antigen( PSA),and prostate specific membrane antigen( PSMA) levels.Methods One hundred and twenty cases of prostate cancer patients undergoing surgery in our hospital between October 2013 and December 2015 were selected and equally divided into the LRP group( using laparoscopic radical prostatectomy) and the RRP group( using open postpubic prostatectomy) according to surgical methods. The duration of surgery,amount of blood loss,catheter indwelling time,length of hospital stay,positive margin rate,one-year urinary control rate,and serum levels of miR-146a,PSA and PSMA were compared between the two groups.Results The duration of surgery of the LRP group was longer than that of the RRP group( P<0.05). The blood loss,catheter indwelling time and length of hospital stay in the LRP group were less or shorter than those in the RRP group( P<0.05). The positive rate of cutting margins in the two groups was not significantly different( P>0.05).The one-year urinary control rate in the LRP group was 91.67%,much higher than 76.67% in the RRP group( P<0.05). Before surgery,the difference of miR-146a,PSA and PSMA levels was not statistically significant between the two groups( P > 0. 05).Three months after operation,serum levels of miR-146a,PSA,and PSMA in both groups were significantly lower( P<0.05),but were not statistically different between the two groups( P>0.05). The erectile dysfunction rate,urinary tract infection rate,and incision infection rate was significantly lower in the LRP group than in the RRP group( P<0.05).Conclusion The clinical efficacy of LRP in the treatment of prostate cancer is comparable to that of RRP surgery,both of which can significantly reduce serum miR-146a,PSA,and PSMA levels,but LRP has the advantages of less surgical trauma,high postoperative urinary control rate,and fewer complications.
Objective To investigate the clinical effect of laparoscopic radical prostatectomy( LRP) against prostate cancer and its effect on serum miR-146 a,prostate cancer specific antigen( PSA),and prostate specific membrane antigen( PSMA) levels.Methods One hundred and twenty cases of prostate cancer patients undergoing surgery in our hospital between October 2013 and December 2015 were selected and equally divided into the LRP group( using laparoscopic radical prostatectomy) and the RRP group( using open postpubic prostatectomy) according to surgical methods. The duration of surgery,amount of blood loss,catheter indwelling time,length of hospital stay,positive margin rate,one-year urinary control rate,and serum levels of miR-146a,PSA and PSMA were compared between the two groups.Results The duration of surgery of the LRP group was longer than that of the RRP group( P<0.05). The blood loss,catheter indwelling time and length of hospital stay in the LRP group were less or shorter than those in the RRP group( P<0.05). The positive rate of cutting margins in the two groups was not significantly different( P>0.05).The one-year urinary control rate in the LRP group was 91.67%,much higher than 76.67% in the RRP group( P<0.05). Before surgery,the difference of miR-146a,PSA and PSMA levels was not statistically significant between the two groups( P > 0. 05).Three months after operation,serum levels of miR-146a,PSA,and PSMA in both groups were significantly lower( P<0.05),but were not statistically different between the two groups( P>0.05). The erectile dysfunction rate,urinary tract infection rate,and incision infection rate was significantly lower in the LRP group than in the RRP group( P<0.05).Conclusion The clinical efficacy of LRP in the treatment of prostate cancer is comparable to that of RRP surgery,both of which can significantly reduce serum miR-146a,PSA,and PSMA levels,but LRP has the advantages of less surgical trauma,high postoperative urinary control rate,and fewer complications.
引文
[1]韩雪迪.前列腺特异性膜抗原靶向分子探针在前列腺癌诊断及治疗中的应用[J].中国医学影像学杂志,2016,24(10):790.
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[4]李利军,刘竞,马志伟.腹腔镜与机器人辅助腹腔镜前列腺癌根治术治疗前列腺癌的效果比较[J].广东医学,2017,38(4):563.
[5]翁锡君,谢立平,郑祥义,等.前列腺特异性抗原密度预测前列腺癌包膜侵犯的价值研究[J].中国全科医学,2016,19(20):2406.
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[7]廖义翔,周家杰,刘涛,等.穿刺活检未证实为前列腺癌的血清前列腺特异性抗原阳性的原发部位不明的肿瘤一例报道并文献复习[J].中国全科医学,2017,20(24):3043.
[8]李文,李胜凯,林优,等.3.0T磁共振DWI、ADC、MRS联合前列腺特异性抗原诊断前列腺癌效能分析[J].实用医学杂志,2017,33(9):1502.
[9]OU Y C,WENG W C,CHANG K S,et al.Prophylactic robotic-assisted laparoscopic radical prostatectomy for preoperative suspicion of prostate cancer:experience with 55cases[J].Anticancer Res,2016,36(9):4895.
[10]康振,张配配,李拔森,等.前列腺影像报告与数据系统对前列腺特异性抗原灰区前列腺癌的诊断价值[J].重庆医学,2017,46(22):3050.
[11]郭宏骞,李笑弓,甘卫东,等.保留Retzius间隙的机器人辅助腹腔镜下根治性前列腺切除术治疗早期前列腺癌(附手术视频)[J].中华男科学杂志,2017,23(1):34.
[12]OSTROWSKI A,KADLUBOWSKI M,TYLOCH D,et al.Safety of laparoscopic radical cystectomy in clinical T4very high risk prostate cancer patients[J].Eur Urol Suppl,2017,16(11):e2912.
[13]李刚,罗彬,李颂,等.经直肠超声引导下穿刺活检术结合血清前列腺特异抗原水平在老年前列腺癌中的应用价值[J].中国老年学杂志,2016,36(13):3202.
[14]KAUFFMAN E C,LEE M J,ALARCON S V,et al.Lack of impact of robotic-assisted laparoscopic radical prostatectomy on intraoperative levels of prostate cancer circulating tumor cells[J].J Urol,2016,195(4):1136.
[15]雷李智,许乙凯,侯美蓉,等.前列腺影像报告和数据系统联合前列腺特异性抗原的Logistic回归模型评价外周带前列腺癌的诊断效能[J].南方医科大学学报,2017,37(8):1092.
[2]江东根,黄群雄,庞俊,等.单孔经膀胱腹腔镜下前列腺癌根治术39例临床分析[J].中华外科杂志,2016,54(10):751.
[3]王祺,李彦锋,江军,等.血清前列腺特异性抗原对前列腺癌患者Gleason评分的预测价值[J].第三军医大学学报,2016,38(9):1021.
[4]李利军,刘竞,马志伟.腹腔镜与机器人辅助腹腔镜前列腺癌根治术治疗前列腺癌的效果比较[J].广东医学,2017,38(4):563.
[5]翁锡君,谢立平,郑祥义,等.前列腺特异性抗原密度预测前列腺癌包膜侵犯的价值研究[J].中国全科医学,2016,19(20):2406.
[6]ABDOLLAH F,DALELA D,SOOD A,et al.Intermediateterm cancer control outcomes in prostate cancer patients treated with robotic-assisted laparoscopic radical prostatectomy:a multi-institutional analysis[J].World J Urol,2016,34(10):1357.
[7]廖义翔,周家杰,刘涛,等.穿刺活检未证实为前列腺癌的血清前列腺特异性抗原阳性的原发部位不明的肿瘤一例报道并文献复习[J].中国全科医学,2017,20(24):3043.
[8]李文,李胜凯,林优,等.3.0T磁共振DWI、ADC、MRS联合前列腺特异性抗原诊断前列腺癌效能分析[J].实用医学杂志,2017,33(9):1502.
[9]OU Y C,WENG W C,CHANG K S,et al.Prophylactic robotic-assisted laparoscopic radical prostatectomy for preoperative suspicion of prostate cancer:experience with 55cases[J].Anticancer Res,2016,36(9):4895.
[10]康振,张配配,李拔森,等.前列腺影像报告与数据系统对前列腺特异性抗原灰区前列腺癌的诊断价值[J].重庆医学,2017,46(22):3050.
[11]郭宏骞,李笑弓,甘卫东,等.保留Retzius间隙的机器人辅助腹腔镜下根治性前列腺切除术治疗早期前列腺癌(附手术视频)[J].中华男科学杂志,2017,23(1):34.
[12]OSTROWSKI A,KADLUBOWSKI M,TYLOCH D,et al.Safety of laparoscopic radical cystectomy in clinical T4very high risk prostate cancer patients[J].Eur Urol Suppl,2017,16(11):e2912.
[13]李刚,罗彬,李颂,等.经直肠超声引导下穿刺活检术结合血清前列腺特异抗原水平在老年前列腺癌中的应用价值[J].中国老年学杂志,2016,36(13):3202.
[14]KAUFFMAN E C,LEE M J,ALARCON S V,et al.Lack of impact of robotic-assisted laparoscopic radical prostatectomy on intraoperative levels of prostate cancer circulating tumor cells[J].J Urol,2016,195(4):1136.
[15]雷李智,许乙凯,侯美蓉,等.前列腺影像报告和数据系统联合前列腺特异性抗原的Logistic回归模型评价外周带前列腺癌的诊断效能[J].南方医科大学学报,2017,37(8):1092.