腹腔镜下根治性前列腺切除术治疗TURP术后偶发前列腺癌的配对分析

目的探讨经尿道前列腺切除术(TURP)后偶发前列腺癌行腹腔镜根治性前列腺切除术(LRP)在外科手术、肿瘤学及尿控等方面的影响。方法回顾性分析自2012年1月至2017年12月北部战区总医院泌尿外科285例接受了LRP治疗的男性患者的临床资料。其中37例患者术前已接受过TURP治疗(TURP组),另外选取37例没有接受过TURP的患者与之配对(对照组)。运用相关统计学方法比较两组患者在围手术期并发症、外科手术、肿瘤及尿控等方面的差异。结果两组患者在年龄、体质指数、血清前列腺特异性抗原(PSA)水平以及术前和术后Gleason评分等方面无统计学差异。TURP组与对照组相比患者出血量较多(555.4±238.4)vs.(237±111.3)mL,P<0.05]、手术时间较长(256.7±65.3)vs.(215.2±62.3)min,P<0.05]、输血概率大(5.4%vs.0.0%,P<0.05)、并发症发生率较高(43.2%vs.13.5%,P<0.05)。TURP组的手术阳性切缘率与对照组相比(35.1%vs.24.3%)差异无统计学意义(P=0.353)。手术后12个月的尿控率两组相似,但在3个月时TURP组的尿控率较低(40.5%vs.70.2%)。在平均随访36.5个月后,TURP组和对照组分别有10.8%和8.1%的患者出现生化复发,差异无统计学意义。结论TURP后LRP需要更长的手术时间、失血更多、并发症发生率更高和更差的短期尿控,但两组患者远期肿瘤切除效果及远期尿控没有差异,所以TURP后行LRP的疗效是安全可靠的。

Paired analysis of laparoscopic radical prostatectomy in the treatment of sporadic prostate cancer after TURP

Objective To investigate the effects of laparoscopic radical prostatectomy(LRP)for sporadic prostate cancer after transurethral prostatectomy(TURP).Methods Clinical data of 285 patients treated with LRP in our department during Jan.2012 and Dec.2017 were retrospectively analyzed.Among them,37 who received TURP before surgery were classified into TURP group,and37 who had not received TURP were selected as the control group.The differences in perioperative complications,surgery,tumor and urinary control were compared between the two groups.Results There were no statistically significant differences between the two groups in patients\age,body mass index(BMI),serum prostate-specific antigen(PSA)level,and preoperative and postoperative Gleason scores.Compared with the control group,TURP group had more blood loss(555.4±238.4)vs.(237±111.3)mL,P<0.05],longer operation time(256.7±65.3)vs.(215.2±62.3)min,P<0.05],higher transfusion probability(5.4%vs.0%,P<0.05)and higher complication rate(43.2%vs.13.5%,P<0.05).The TURP group also had higher positive surgical margin rate than the control group(35.1%vs.24.3%),but the difference was not statistically significant(P=0.353).The TURP group had lower urinary control rate than the control group3 months after surgery(40.5%vs.70.2%),but comparable urinary control 12 months after surgery.After an average follow-up of 36.5 months,10.8%patients in the TURP group and8.1%in the control group developed biochemical recurrence,and the difference was not statistically significant.Conclusion LRP after TURP has longer operation time,more blood loss,higher incidence of complications and worse short-term urinary control,but there are no differences in long-term tumor resection and urinary control between the two groups,so LRP after TURP is safe and effective.