高危前列腺癌患者腹腔镜与开放手术疗效分析
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摘要
目的研究并探讨高危前列腺癌患者腹腔镜和开放手术之间的疗效对比。方法回顾性研究分析2011年1月至2015年12月重庆市开州区人民医院收治且随访成功的100例高危前列腺癌手术患者的临床资料,按照患者的手术方式将其分为腹腔镜组、开放手术组,开放手术组患者接受开放式耻骨后根治性前列腺切除术,腹腔镜组患者接受腹腔镜根治性前列腺切除术,比较两组患者的手术时间、术中出血量、胃肠功能恢复时间、住院时间、术后并发症发生率、术后远期生存率、勃起功能恢复率以及控尿率。结果两者患者的手术时间、术中出血量、胃肠功能恢复时间、住院时间差异具有统计学意义(P <0. 05),术后并发症发生率、术后远期生存率、控尿率差异均无统计学意义(均P> 0. 05);腹腔镜组患者的勃起功能恢复率为61. 22%,明显高于对开放的39. 22%,差异具有统计学意义(P <0. 05)。结论腹腔镜根治性前列腺切除术,可以有效缩短手术时间,促进术后恢复,同时可以有效恢复患者的术后勃起功能。
Objective To study and explore the effectiveness of radical prostatectomy for the treatment of high-risk prostate cancer. Methods Retrospective analysis of our hospital in December and the successful followup of 100 cases of patients with high-risk prostate cancer surgery clinical data of January 2011 ～ 2015,according to the operation mode were divided into control group and observation group. The control group underwent open retropubic radical prostatectomy,observation group patients underwent laparoscopic radical prostatectomy,two groups were compared operative time,intraoperative blood loss,gastrointestinal function recovery time,hospitalization time,postoperative complications and long-term survival rate of postoperative erectile function recovery rate and control urine rate. Results The observation group of patients with operation time,intraoperative blood loss,gastrointestinal function recovery time,hospitalization time and the control group( P < 0. 05),there was a significant difference between the two groups of patients after operation The complication rate had no significant difference( P > 0. 05); the patients in the observation group and the control group of patients with postoperative survival rate,compared to control urine rate,there were no significant differences( P > 0. 05); the observation group of patients with erectile function recovery rate was 61. 22%,significantly higher than the control group 39. 22%( P < 0. 05). Conclusions The radical prostate resection in the treatment of high-risk prostate cancer is feasible,the effect is significant,especially in laparoscopic radical prostatectomy,can effectively shorten the operation time,promote postoperative recovery,and can effectively restore the patient's postoperative erectile function.
Objective To study and explore the effectiveness of radical prostatectomy for the treatment of high-risk prostate cancer. Methods Retrospective analysis of our hospital in December and the successful followup of 100 cases of patients with high-risk prostate cancer surgery clinical data of January 2011 ～ 2015,according to the operation mode were divided into control group and observation group. The control group underwent open retropubic radical prostatectomy,observation group patients underwent laparoscopic radical prostatectomy,two groups were compared operative time,intraoperative blood loss,gastrointestinal function recovery time,hospitalization time,postoperative complications and long-term survival rate of postoperative erectile function recovery rate and control urine rate. Results The observation group of patients with operation time,intraoperative blood loss,gastrointestinal function recovery time,hospitalization time and the control group( P < 0. 05),there was a significant difference between the two groups of patients after operation The complication rate had no significant difference( P > 0. 05); the patients in the observation group and the control group of patients with postoperative survival rate,compared to control urine rate,there were no significant differences( P > 0. 05); the observation group of patients with erectile function recovery rate was 61. 22%,significantly higher than the control group 39. 22%( P < 0. 05). Conclusions The radical prostate resection in the treatment of high-risk prostate cancer is feasible,the effect is significant,especially in laparoscopic radical prostatectomy,can effectively shorten the operation time,promote postoperative recovery,and can effectively restore the patient's postoperative erectile function.
引文
[1] Satoko H,Keiji H,Ryo-ichi Y,et al. Salvage radiotherapy after radical prostatectomy:outcomes and prognostic factors especially focusing on pathological findings[J]. Journal of Radiation Research,2012,53(5):727-734.
[2]黄群雄,罗子寰,周芳坚,等.开放与腹腔镜下根治性前列腺切除术治疗局限和局部高危前列腺癌的对比研究[J].中华泌尿外科杂志,2015,36(8):583-587.
[3]刘圣杰,朱刚.根治性前列腺切除术在高危前列腺癌治疗中的作用[J].中华泌尿外科杂志,2015,36(11):872-874.
[4] Johnson SB,Hamstra DA,Jackson WC,et al. Larger maximum tumor diameter at radical prostatectomy is associated with increased biochemical failure,metastasis,and death from prostate cancer after salvage radiation for prostate cancer[J]. International Journal of Radiation Oncology,Biology,Physics,2013,87(2):275-281.
[5]许天源,钟山,王先进,等.机器人辅助腹腔镜手术治疗高危前列腺癌的应用与优势[J].中华泌尿外科杂志,2015,36(7):518-522.
[6]陈达,阎乙夫,夏溟,等.不同手术方式治疗局限性高危的比较研究[J].中华泌尿外科杂志,2014,35(9):672-675.
[7]邵鹏飞,殷长军,李杰,等.腹腔镜下前列腺癌根治术治疗高危前列腺癌的临床效果分析[J].中华外科杂志,2015,53(11):847-851.
[8] Shinohara N,Maruyama S,Shimizu S,et al. Longitudinal comparison of quality of life after real-time tumor-tracking intensity-modulated radiation therapy and radical prostatectomy in patients with localized prostate cancer[J]. Journal of Radiation Research,2013,54(6):1095-1101.
[9]刘伟华,金晓东,周亮,等.前列腺癌根治术对高危前列腺癌患者的临床疗效[J].中华全科医学,2015,13(4):568-570,604.
[10]乔鹏,邢念增.经腹膜外腹腔镜前列腺癌根治术治疗高危前列腺癌的临床研究(附49例报告)[J].中国内镜杂志,2016,22(2):87-90.
[11] Jeffrey KM,Zhaoyong F,Bruce JT,et al. The impact of anatomical radical retropubic prostatectomy on cancer control:The 30-year anniversary[J]. The Journal of Urology,2012,188(1):2219-2224.
[12]程晓冬,吴岩,马贵,等.腹腔镜技术在高危前列腺癌根治术中的应用[J].中国微创外科杂志,2015,15(11):1028-1030,1037.
[13]潘杰,谢文锋,吴俊雁,等.腹腔镜前列腺癌根治术在早期前列腺癌治疗中的应用效果探讨[J].临床医学工程,2016,23(8):991-992.
[14] Nobuki F,Motonobu N,Ken H,et al. Radical prostatectomy as radical cure of prostate cancer in a high-riskgroup:A single-institution experience[J]. Molecular and Clinical Oncology,2013,1(2):337-342.
[15]杨逢生,李宝兴,刘文泓,等.经腹与经腹膜外途径腹腔镜前列腺癌根治术疗效比较的Meta分析[J].中华腔镜泌尿外科杂志(电子版),2016,10(5):11-14.
[16] Zhang AY,Bodner DR,Fu AZ,et al. Effects of patient centered interventions on Persistent Urinary Incontinence after Prostate Cancer Treatment:A randomized,controlled trial[J]. The Journal of Urology,2015,194(6):1675-1681.
[17] Morey MC,Blair CK,Sloane R,et al. Group trajectory analysis helps to identify older cancer survivors who benefit from distance-based lifestyle interventions[J]. Cancer,2015,121(24):4433-4440.
[18] Ghadjar P,Hayoz S,Bernhard J,et al. Acute toxicity and quality of life after dose-intensified salvage radiation therapy for biochemically recurrent prostate cancer after prostatectomy:First results of the randomized trial SAKK 09/10[J]. Journal of Clinical Oncology,2015,33(35):4158-4166.
[2]黄群雄,罗子寰,周芳坚,等.开放与腹腔镜下根治性前列腺切除术治疗局限和局部高危前列腺癌的对比研究[J].中华泌尿外科杂志,2015,36(8):583-587.
[3]刘圣杰,朱刚.根治性前列腺切除术在高危前列腺癌治疗中的作用[J].中华泌尿外科杂志,2015,36(11):872-874.
[4] Johnson SB,Hamstra DA,Jackson WC,et al. Larger maximum tumor diameter at radical prostatectomy is associated with increased biochemical failure,metastasis,and death from prostate cancer after salvage radiation for prostate cancer[J]. International Journal of Radiation Oncology,Biology,Physics,2013,87(2):275-281.
[5]许天源,钟山,王先进,等.机器人辅助腹腔镜手术治疗高危前列腺癌的应用与优势[J].中华泌尿外科杂志,2015,36(7):518-522.
[6]陈达,阎乙夫,夏溟,等.不同手术方式治疗局限性高危的比较研究[J].中华泌尿外科杂志,2014,35(9):672-675.
[7]邵鹏飞,殷长军,李杰,等.腹腔镜下前列腺癌根治术治疗高危前列腺癌的临床效果分析[J].中华外科杂志,2015,53(11):847-851.
[8] Shinohara N,Maruyama S,Shimizu S,et al. Longitudinal comparison of quality of life after real-time tumor-tracking intensity-modulated radiation therapy and radical prostatectomy in patients with localized prostate cancer[J]. Journal of Radiation Research,2013,54(6):1095-1101.
[9]刘伟华,金晓东,周亮,等.前列腺癌根治术对高危前列腺癌患者的临床疗效[J].中华全科医学,2015,13(4):568-570,604.
[10]乔鹏,邢念增.经腹膜外腹腔镜前列腺癌根治术治疗高危前列腺癌的临床研究(附49例报告)[J].中国内镜杂志,2016,22(2):87-90.
[11] Jeffrey KM,Zhaoyong F,Bruce JT,et al. The impact of anatomical radical retropubic prostatectomy on cancer control:The 30-year anniversary[J]. The Journal of Urology,2012,188(1):2219-2224.
[12]程晓冬,吴岩,马贵,等.腹腔镜技术在高危前列腺癌根治术中的应用[J].中国微创外科杂志,2015,15(11):1028-1030,1037.
[13]潘杰,谢文锋,吴俊雁,等.腹腔镜前列腺癌根治术在早期前列腺癌治疗中的应用效果探讨[J].临床医学工程,2016,23(8):991-992.
[14] Nobuki F,Motonobu N,Ken H,et al. Radical prostatectomy as radical cure of prostate cancer in a high-riskgroup:A single-institution experience[J]. Molecular and Clinical Oncology,2013,1(2):337-342.
[15]杨逢生,李宝兴,刘文泓,等.经腹与经腹膜外途径腹腔镜前列腺癌根治术疗效比较的Meta分析[J].中华腔镜泌尿外科杂志(电子版),2016,10(5):11-14.
[16] Zhang AY,Bodner DR,Fu AZ,et al. Effects of patient centered interventions on Persistent Urinary Incontinence after Prostate Cancer Treatment:A randomized,controlled trial[J]. The Journal of Urology,2015,194(6):1675-1681.
[17] Morey MC,Blair CK,Sloane R,et al. Group trajectory analysis helps to identify older cancer survivors who benefit from distance-based lifestyle interventions[J]. Cancer,2015,121(24):4433-4440.
[18] Ghadjar P,Hayoz S,Bernhard J,et al. Acute toxicity and quality of life after dose-intensified salvage radiation therapy for biochemically recurrent prostate cancer after prostatectomy:First results of the randomized trial SAKK 09/10[J]. Journal of Clinical Oncology,2015,33(35):4158-4166.