保留Retzius间隙的机器人前列腺癌根治术在前列腺中叶突出患者中的应用

目的报道首个应用保留Retzius间隙的机器人前列腺癌根治术(RS-RARP)治疗具有前列腺中叶突出(PML)的前列腺癌患者的病例系列研究,并评价RS-RARP在PML前列腺癌患者中的应用价值。方法收集2017年7月至2019年1月间于南京大学医学院附属鼓楼医院泌尿外科(南京大学泌尿外科研究所)接受同一外科医生行RS-RARP手术的有着明显PML的局限性前列腺癌患者的临床资料。所有患者行前列腺多参数核磁共振(mpMRI)检查。PML由T2加权的正中矢状面图像上进行测量。所有患者随访时间超过1个月。所有患者的病理切片由同一名泌尿外科病理医师进行判读。对患者基本情况、围手术期结果、切缘阳性率和早期尿控恢复进行研究。结果本研究共入组患者41例,中位年龄、中位体质量指数(BMI)、中位初始前列腺特异性抗原(PSA)水平、中位经直肠超声前列腺体积、中位PML、中位手术用时、中位估计手术出血量及中位住院时间分别为:70.0(67～75)岁, 24.0(21.7～26.3)kg/m~2, 8.4(5.5～15.4) ng/ml,40.8(32.4～47.4) ml,11.6(10.5～13.1)mm,155.0(140.0～185.0)min,200.0(125～300)ml,5.0(4.5～8.0)d。研究中,共有7例患者切缘阳性,总体切缘阳性率为17.1%(7/41)。前列腺基底切缘阳性率为0。在pT2期患者中,切缘阳性率为7.7%(2/26);在pT3期患者中,切缘阳性率为33.3%(5/15)。65.9%(27/41)的患者术后1个月内即恢复尿控, 51.2%(21/41)的患者术后即刻恢复尿控。结论对于PML患者,保留Retzius间隙的机器人辅助根治性前列腺癌切除术(RS-RARP)在控制切缘阳性率的前提下,能够改善患者术后早期尿控的恢复。     

头侧站位三孔法经腹膜外途径腹腔镜根治性前列腺切除术的临床应用与初步体会

目的:探讨头侧站位三孔法经腹膜外途径腹腔镜根治性前列腺切除术的临床应用价值与体会。方法:收集于2012年01月至2019年12月行根治性前列腺切除术的111例患者资料，其中56例患者采用常规体侧站位（四孔或五孔）经腹膜外途径腹腔镜根治性前列腺切除术（A组:体侧站位组），55例患者采用头侧站位三孔法经腹膜外途径腹腔镜根治性前列腺切除术（B组:头侧站位组），比较两组病例围手术期指标和术者疲劳度差异。结果:两组患者手术时间、术中出血量、术中输血率、引流管留置时间、生化复发、尿失禁、切缘阳性率和术后PSA方面无统计学差异（P＞0.05），头侧站位组患者术后住院时间更短。两组术者肩部、双上臂、胸部、双下肢疲劳度和1小时内眨眼频率无统计学差异（P＞0.05），头侧站位组术者颈部、腰背部疲劳度更低且超过1小时后术者的眨眼频率更少（P＜0.05）。结论:头侧站位三孔法经腹膜外途径腹腔镜根治性前列腺切除术并未明显增加手术难度，该术式优点在于患者术后恢复更快。头侧站位组术者、术野和显示屏三点位于一线，可以明显缓解术者及助手发生肌肉疲劳。     

保留Retzius间隙的机器人辅助前列腺癌根治术术后早期尿控的预测因素分析

目的评估接受保留Retzius间隙的机器人辅助前列腺癌根治术(RS-RARP)患者术后尿失禁情况,以确定患者术后早期尿控的预测因素。方法收集2018年2月至2018年12月在南京大学医学院附属鼓楼医院泌尿外科接受保留Retzius间隙的机器人辅助前列腺癌根治术(RS-RARP)患者的临床资料,对其中接受同一外科医生手术治疗的101例局限性前列腺癌患者进行回顾性研究。建立Logistic回归模型分析早期尿控的独立影响因素。结果 80例患者(79.21%)在RS-RARP术后能够早期尿控。RS-RARP术后早期尿控患者较早期尿失禁患者年轻,前列腺体积更小,术前IPSS评分更低,差异均有统计学意义(均P0.05)。单因素回归分析显示患者年龄(OR=0.903,P=0.045)、术前IPSS(OR=0.940,P=0.039)、前列腺体积(OR=0.925,P0.001)为早期尿控的影响因素;多因素回归分析显示术前IPSS(OR=0.928,P=0.047)、前列腺体积(OR=0.917,P0.001)为早期尿控的独立影响因素;多元线性回归模型显示:IPSS、前列腺体积为早期尿控的独立不良预测因素(R~2=0.272,P0.001)。结论保留Retzius间隙的机器人辅助前列腺癌根治术(RS-RARP)有助于患者术后即时尿控;前列腺体积和术前严重IPSS是患者术后早期尿控的独立不良预测因素。     

保留Retzius间隙的机器人前列腺癌根治术在前列腺中叶突出患者中应用

目的   报道首个应用保留Retzius间隙的机器人前列腺癌根治术(RS RARP)治疗具有前列腺中叶突出(PML)的前列腺癌患者的病例系列研究,并评价RS RARP在PML前列腺癌患者中的应用价值。方法   收集2017年7月至2019年1月间于南京大学医学院附属鼓楼医院泌尿外科(南京大学泌尿外科研究所)接受同一外科医生行RS RARP手术的有着明显PML的局限性前列腺癌患者的临床资料。所有患者行前列腺多参数核磁共振(mpMRI)检查。PML由T2加权的正中矢状面图像上进行测量。所有患者随访时间超过1个月。所有患者的病理切片由同一名泌尿外科病理医师进行判读。对患者基本情况、围手术期结果、切缘阳性率和早期尿控恢复进行研究。结果  本研究共入组患者41例,中位年龄、中位体质量指数(BMI)、中位初始前列腺特异性抗原(PSA)水平、中位经直肠超声前列腺体积、中位PML、中位手术用时、中位估计手术出血量及中位住院时间分别为:700(67～75)岁, 240(217～263)kg／m2, 84(55～154) ng／ml,408(324～474) ml,116(105～131)mm,1550(1400～1850)min,2000(125～300)ml,50(45～80)d。研究中,共有7例患者切缘阳性,总体切缘阳性率为171％（7/41）。前列腺基底切缘阳性率为0。在pT2期患者中,切缘阳性率为77％(2／26);在pT3期患者中,切缘阳性率为333％(5／15)。659％(27／41)的患者术后1个月内即恢复尿控, 512％(21／41)的患者术后即刻恢复尿控。结论 对于PML患者,保留Retzius间隙的机器人辅助根治性前列腺癌切除术(RS RARP)在控制切缘阳性率的前提下,能够改善患者术后早期尿控的恢复。 【关键词】前列腺癌根治术;机器人辅助;保留Retzius间隙;中叶突出;切缘阳性率;早期尿控 doi：10.3969/j.issn.1674-4136.2019.02.002 文章编号：1674-4136（2019）02-0083-05 Application of Retzius sparing robot assisted radical prostatectomy for patients with median lobe protrusionXU Liu, ZHANG Mengjie, ZHUANG Junlong,QIU Xuefeng, XU Linfeng, GUO Hongqian.(Department of Urology, Drum Tower Hospital, Medical School of Nanjing University;Institute of Urology, Nanjing University, Nanjing 210008, China) Corresponding author: GUO Hongqian, Email: dr.ghq@nju.edu.cn 【Abstract】ObjectiveTo introduce the first case series receiving RS RARP for prostate cancer with PML, and evaluate the potential advantage. MethodsConsecutive clinical data of patients with significant PML who received RS RARP by the same surgeon in our center between July 2017 and January 2019 was analyzed retrospectively. All patients underwent pelvic mpMRI which PML measured from. All pathologic images were confirmed by a genitourinary pathologist. The basic information, perioperative outcomes, rate of positive surgical margin and early urinary continence were analyzed. ResultsThe median age, BMI, preoperative total PSA level, prostate volume, PML, operative time, estimated blood loss and length of hospital stay were 700(67 75)years,240(217 263)kg／m2, 84(55 154)ng／ml, 408(324 474) ml,116(105 131)mm,1550(1400 1850)min, 2000(125 300)ml,50(45 80)days,respectively. The rate of PSM was 171％(7／41).None had positive base surgical margin. The rates of PSM were 77％(2／26) and 333％(5／15) in pT2 and pT3 patients, respectively. 659％(27／41) of the patients were continent within 1 month, and 512％(21／41) patients were continent within 1 week.  ConclusionsRS RARP can improve early urinary continence with a well positive surgical margin control in PML.     

经腹与腹膜后入路机器人辅助腹腔镜肾部分切除术治疗早期肾癌的比较

目的 分析比较经腹与腹膜后两种入路在机器人（达芬奇机器人手术系统）辅助腹腔镜肾部分切除术治疗早期肾癌的效果,并探讨两种入路方式的临床应用价值。方法 2011年12月至2015年2月共收治82例行机器人辅助腹腔镜肾部分切除术的肾癌患者,其中49例采取经腹入路,33例行腹膜后入路。比较两种入路的手术时间、肾动脉阻断时间、术中出血量、术后肠道功能恢复时间、切缘阳性率以及术后并发症的发生率。结果 两组均成功完成手术。两组在手术时间、肾动脉阻断时间、术中出血量、切缘阳性率及术后并发症发生率方面的差异均无统计学意义（P＞0.05）;经腹与腹膜后入路术后的肠道功能恢复时间分别为（5.7±1.4）d和（2.1±0.7）d,差异有统计学意义（P＜0.05）。结论 腹膜后入路机器人辅助腹腔镜肾部分切除术是一种安全、有效的微创术式,可以取得与经腹入路同样的手术效果,并且在术后肠道功能恢复方面具有优势。     

微创手术治疗前列腺癌的疗效研究

目的：探讨经腹腔入路腹腔镜微创手术治疗前列腺癌患者的临床效果。方法选取经腹腔入路腹腔镜微创手术治疗的53例患者作为微创组,及采用开放经耻骨前列腺癌根治术治疗的47例患者作为对照组,比较两组患者手术相关指标及并发症的发生率。结果两组患者术后淋巴结阳性率、精囊阳性率、切缘阳性率差异均无统计学意义（P﹥0.05）;微创组患者的手术时间长于对照组患者,差异有统计学意义（P﹤0.05）;微创组患者术中出血量、导尿管留置时间、胃肠道功能恢复时间、术后下床时间、住院时间均低于对照组患者,差异有统计学意义（P﹤0.05）;术后3个月、6个月,两组患者尿控率、生化复发率差异均无统计学意义（P﹥0.05）。结论经腹腔入路腹腔镜微创手术治疗前列腺癌与传统开腹手术效果相当,但是具有手术创伤小、恢复快的优势。     

机器人辅助在前列腺癌外科治疗的研究进展

前列腺癌发病率和死亡率逐年升高,开放性根治性前列腺切除术仍是局部晚期前列腺癌的治疗金标准。近年来,腹腔镜和机器人辅助前列腺切除术等微创技术已广泛应用,与传统开放性手术比较,其在肿瘤切缘控制、尿控能力和性功能等方面取得巨大进步。另外机器人辅助前列腺切除术在改善患者功能学方面更具优势。本综述就根治性前列腺切除术的发展、不同手术入路的选择、围手术期并发症、肿瘤学、功能学及学习曲线等方面阐述机器人运用在前列腺癌根治术中的进展。     

加速康复外科与传统围手术期管理模式在机器人辅助腹腔镜前列腺癌根治术的临床疗效对比分析

目的将加速康复外科(ERAS)围手术期管理模式应用于机器人辅助腹腔镜前列腺癌根治术(RARP),并对比传统围手术期管理模式与ERAS的临床实践效果差异。 方法回顾性分析2018年5月至2018年8月南京大学医学院附属鼓楼医院泌尿外科共110例行机器人辅助腹腔镜根治性前列腺切除术患者的临床资料,并按照筛选条件最终纳入共70例患者,采用RARP术,且均采用ERAS围手术期管理模式,为ERAS组。并按照纳入标准纳入既往于南京大学医学院附属鼓楼医院泌尿外科2017年5月至2018年4月行RARP但未行加速康复外科围手术期管理模式的70例患者为对照组。ERAS组与对照组患者在年龄、体质量指数、术前实验室检查如血清白蛋白及血红蛋白、前列腺体积、术前PSA、术前ECOG评分、EPIC评分、临床分期和Gleason评分的差异均无统计学意义(P>005)。 结果两组手术均顺利完成,围手术期未出现病死或严重并发症,患者均顺利出院。术中情况:ERAS组与对照组在手术时间、术中出血量、术中直肠损伤、闭孔神经损伤、大血管损伤、淋巴结清扫比率差异均无统计学意义(P>005)。术后情况:ERAS组与传统围手术管理组在回病房后至首次进食时间、首次活动时间、首次排气时间、术后6 h疼痛评分、住院天数差异均有统计学意义(P<005),术后Clavien Dindo并发症分级、切缘阳性情况、术后实验室指标差异及术后1周及术后1个月早期尿控恢复差异无统计学意义(P>005)。 结论将加速康复外科围手术期管理模式应用于机器人辅助腹腔镜前列腺癌根治术,较传统围手术期管理模式更能促进患者康复,缓解术后疼痛,缩短住院天数。     

经尿道辅助单孔腹腔镜下根治性膀胱切除联合原位回肠新膀胱术的疗效及安全性

目的:探讨单孔腹腔镜下根治性膀胱切除术联合原位回肠新膀胱术的疗效及安全性。方法:选取2017年01月至2019年12月于本中心收治的17例膀胱癌患者,其中7例患者在经尿道途径的辅助下行单孔腹腔镜根治性膀胱切除术联合原位回肠新膀胱术;另外10例为对照组,行多孔腹腔镜下根治性膀胱切除术联合原位回肠新膀胱术,并对两组患者围手术期资料、手术并发症以及术后随访情况进行分析。结果:两组共17例膀胱癌患者均顺利完成手术,无中转开放手术。两组患者的年龄、体质量指数（body mass index,BMI)等差异均无统计学意义（P＞0.05）。单孔组与对照组平均手术时间分别为（341.4±52.1）min和（333.0±59.5）min,术中平均出血量分别为（206.4±104.6）mL和（190.5±82.3）mL,盆腔淋巴结清扫平均个数分别为17（7~22）个和18（12~23）个,术后平均住院天数分别为（25.1±5.4）d和（26.8±6.0）d,差异均无统计学意义（P＞0.05）。而单孔组在术后VAS疼痛评分和切口满意度评分上则优于对照组（P＜0.05）。其中单孔组患者术后随访12个月时患者的最大尿流量、最大膀胱容量、最大膀胱充盈量均明显比6个月时高,而随访12个月时患者的残余尿量较6个月时低,差异均具有统计学意义（P＜0.05）。结论:经尿道辅助单孔腹腔镜下根治性膀胱切除术联合原位回肠新膀胱术是安全可行的,且术后的新膀胱功能较为良好。     

营养状况控制评分对机器人辅助根治性前列腺切除术后患者尿控情况的预测

目的 探讨术前营养状况控制(CONUT)评分对行机器人辅助根治性前列腺切除术(RARP)的前列腺癌患者术后尿控恢复情况的预测价值。方法 选取2019年1月至2020年1月期间在南京市鼓楼医院泌尿外科接受RARP的前列腺癌患者的临床资料进行回顾性分析。所有患者均自术后拔除导尿管第1日起每月对患者的尿控功能恢复情况进行持续3年的随访,以全天不需要或仅预防性使用1块尿垫作为尿控功能恢复的标准。通过卡方检验、单因素和多因素Cox回归分析,明确影响术后12个月尿控功能恢复的独立危险因素,并用Log-rank检验比较各组间术后尿控功能恢复曲线的统计学意义。结果 单因素Cox回归分析结果显示,年龄(P=0.003)、CONUT评分(P<0.001)、手术方式(P=0.031)是患者尿控预后的相关因素;多因素Cox回归分析结果显示,CONUT评分是患者预后的独立危险因素(P<0.001);Kaplan-Meier法生存分析结果显示,CONUT评分≥4的患者拔除导尿管后12个月的尿控恢复率低于CONUT评分<4的患者(P<0.001)。结论 CONUT评分对根治性切除前列腺癌患者...     

Long-term functional outcomes after robot-assisted prostatectomy compared to laparoscopic prostatectomy: Results from a national retrospective cluster study

BackgroundDespite multiple studies evaluating the effectiveness of Robot-Assisted Radical Prostatectomy (RARP), there is no definitive conclusion about the added value of RARP. A retrospective cluster study was conducted to evaluate long-term sexual and urinary functioning after RARP and Laparoscopic Radical Prostatectomy (LRP) based on real-world data from 12 Dutch hospitals.MethodsData was collected from patients who underwent surgery between 2010 and 2012. A mixed effect model was used to evaluate differences between groups on urinary and sexual functioning (EPIC-26). Additionally, a regression analysis was conducted to evaluate the relationship between these functional outcomes and, among others, hospital volume.Results1370 (65.1%) patients participated, 907 underwent RARP and 463 LRP, with a median follow-up time of 7.08 years (SD = 0.98). The RARP group showed a statistically and clinically significant better urinary functioning compared to the LRP group (p = 0.002). RARP showed also a shorter procedure time (p=<0.001), reduced blood loss (p=<0.001), and a higher chance of neurovascular bundle preservation (39.8% vs 29.1%; p=<0.01).ConclusionRARP resulted in better long-term urinary function compared to LRP. Based on the results from this study, guidelines concerning the preferred surgery type and the position on reimbursement may change, especially when RARP proves to be cost-effective.     

2 μm激光整块切除与电切治疗非肌层浸润性膀胱癌的临床分析

目的:比较2 μm激光整块切除与电切治疗非肌层浸润性膀胱癌的有效性及安全性。方法:回顾性分析2015年4月-2017年4月分别采用经尿道2微米激光整块切除(50例)和经尿道电切(48例)治疗非肌层浸润性膀胱癌患者临床随访资料。结果:所有患者手术均顺利完成，激光组与电切组患者手术时间相当，两组比较差异无统计学意义(P>0.05)，激光组患者留置尿管、膀胱冲洗及住院时间均少于电切组，比较差异有统计学意义(P<0.05)；激光组患者并发症发生率、一年复发率及术区复发率低于电切组，两组比较差异均有统计学意义(P<0.05)；激光组术后病理含肌层率高于电切组，两组比较差异有统计学意义(P<0.05)。结论:经尿道2微米激光整块切除治疗非肌层浸润性膀胱癌是一种安全、有效的治疗方式且术后肿瘤分期精确、减少肿瘤残留，是治疗非肌层浸润性膀胱癌较好的手术治疗选择，值得临床上推广应用。     

用于机器人中低位直肠癌术后预防吻合口漏的一项新技术研究

目的:吻合口漏(anastomotic leakage,AL)是低位直肠癌保肛术后的严重并发症,亟需确切有效的预防措施.本研究旨在评估机器人低位直肠癌前切除术(low anterior resection,LAR)联合创新技术预防AL的临床价值.方法:选取2012年5月至2017年5月,于复旦大学附属中山医院接受机器人...     

Risk factors for intravesical recurrence following urothelial carcinoma of the upper urinary tract: no relationship to the mode of surgery

OBJECTIVE: The aim of this study was to clarify whether intravesical recurrence of upper urinary tract cancer after treatment is related to the mode of surgery or other oncological factors. METHODS: We evaluated 106 patients (mean age 70.4 years; mean follow-up 24.0 months) who underwent surgery for the upper urinary tract cancer at Hiroshima University and its affiliated hospitals between January 1995 and August 2005. Seventy-nine of the patients underwent retroperitoneoscopy-assisted radical nephroureterectomy (RN) and 27 underwent nephroureterectomy by open surgery (OS). Fifty-two patients had renal pelvic tumors, 48 had ureteral tumors, and six had both renal pelvic and ureteral tumors. Twenty-eight (26%) of the 106 patients had a pre-operative history of bladder cancer. We identified the risk factors predicting intravesical recurrence of upper urinary tract cancer according to the type of previous surgery using the Kaplan-Meier method, log-rank test, and univariate and multivariate analysis using the Cox proportional hazards model. RESULTS: Thirty-one (29%) of the 106 patients developed bladder tumors post-operatively. The 2-year intravesical recurrence-free rate was 55% in the RN group and 60% in the OS group. There was no significant difference (P = 0.51, log-rank test) in the rate of intravesical recurrence between the two groups. Multivariate analysis identified only a history of pre-operative bladder tumor (HR = 3.25, P = 0.003) as a predictor of post-operative intravesical recurrence. CONCLUSIONS: Intravesical recurrence after surgery for upper urinary tract cancer is not related to the mode of surgery (i.e. laparoscopy-assisted or open surgery) employed. The only risk factor for intravesical recurrence is a history of bladder cancer.     

Robot-Assisted Radical Prostatectomy for Potential Cancer Control in Patients with Metastatic Prostate Cancer

Recently, cytoreductive prostatectomy for metastatic prostate cancer (mPCa) has been associated with improved oncological outcomes. This study was aimed at evaluating whether robot-assisted radical prostatectomy (RARP) as a form of cytoreductive prostatectomy can improve oncological outcomes in patients with mPCa. We conducted a retrospective study of twelve patients with mPCa who had undergone neoadjuvant therapy followed by RARP. The endpoints were biochemical recurrence-free survival, treatment-free survival, and de novo metastasis-free survival. At the end of the follow-up period, none of the enrolled patients had died from PCa. The 1- and 2-year biochemical recurrence-free survival rates were 83.3% and 66.7%, respectively, and treatment-free survival rates were 75.0% and 56.3%, respectively. One patient developed de novo bone metastases 6.4 months postoperatively, and castration-resistant prostate cancer 8.9 months postoperatively. After RARP, the median duration of recovery of urinary continence was 5.2 months. One patient had severe incontinence (>2 pads/day) 24 months postoperatively. RARP may be a treatment option in patients with mPCa who have achieved a serum prostate-specific antigen level < 0.2 ng/mL, and present without new lesions on imaging.     

机器人与腹腔镜辅助胃癌根治术中复杂部位淋巴结清扫对比研究

  目的  旨在探究机器人与腹腔镜辅助胃癌根治术在复杂部位区域内淋巴结的效果比较。  方法  回顾性分析2014年8月至2015年8月于中国人民解放军总医院接受胃癌根治术的296例患者的临床资料，其中机器人组61例，腹腔镜组235例。收集患者临床特征、手术指标、病理和相关肿瘤数据，并根据手术程度分析各站切除淋巴结的数量。  结果  机器人组的淋巴结清扫数量显著增加（P=0.046），在N2区域也能较腹腔镜组清扫更多的淋巴结（P=0.038）。对于远端胃切除术，机器人组和腹腔镜组可分别切除脾动脉区域的（2.8±1.7）和（2.2±1.2）个淋巴结（P=0.036）。对于全胃切除术，机器人组和腹腔镜组可分别切除脾动脉区域的（2.8±1.2）和（2.1±1.0）枚淋巴结（P=0.049）。脾门周围淋巴结的切除数为（1.8±0.8）和（1.3±0.7）枚（P=0.042），差异具有统计学意义。两组的术中输血率（P=0.617）、术后住院天数（P=0.071）、近端切缘（P=0.064）和远端切缘（P=0.667）无显著差异。术后并发症的发生率也无显著差异（P=0.854），但是根据Clavien-Dindo分级，机器人组的术后并发症程度显著下降（P=0.039）。  结论  机器人辅助胃癌根治术能够在复杂部位的区域淋巴结中发挥更大的优势，并且可能有助于降低根治性D2淋巴结清扫后并发症的严重程度。      

Comparison of Long-Term Oncological Outcomes in Oncoplastic Breast Surgery and Conventional Breast-Conserving Surgery for Breast Cancer: A Propensity Score-Matched Analysis

PurposeThe oncoplastic breast-conserving surgery (OPS) technique, combined with the principles of oncological safety and plastic surgery, results in complete tumor resection while preserving the natural appearance of the breast. The purpose of this study was to evaluate the long-term oncological results after OPS compared with conventional breast-conserving surgery (BCS) for early breast cancer.MethodsThe medical records of patients who underwent breast cancer surgery and adjuvant radiation therapy at Seoul National University Hospital between 2011 and 2014 were reviewed. Ipsilateral breast tumor recurrence (IBTR)-free survival rate and recurrence-free survival (RFS) rates were compared between the OPS and BCS groups.ResultsOne-to-one propensity score matching was conducted, yielding 371 patients in each group. The mean tumor distance from the nipple was shorter, and the mean retrieved specimen size and pathologic tumor size, including ductal carcinoma in situ, were larger in the OPS group than in the conventional BCS group (p < 0.001). Surgical margin positivity was not significantly different between the two groups (p = 0.777). The surgical technique was not significantly associated with IBTR (OPS versus conventional BCS, 5-year survival rate, 96.9% vs. 98.6%; p = 0.355) and RFS (5-year survival rate, 92.9% vs. 94.5%; p = 0.357) on the log-rank test. Multivariate analysis revealed that OPS versus conventional BCS was not significantly associated with survival outcomes.ConclusionWe observed no significant differences in long-term IBTR and RFS between the OPS and conventional BCS groups in this retrospective analysis. OPS can be an oncologically and surgically safe alternative option for conventional BCS for early breast cancer.     

椎旁阻滞联合全麻对结直肠癌切除术患者术后应激反应的影响

目的:探讨椎旁阻滞联合全麻对结直肠癌切除术患者术后应激反应的影响。方法:回顾性分析我院自2015年1月至2017年1月收治的结直肠癌患者104例，根据患者术中采用的麻醉方法，将患者分为观察组(n=58)和对照组(n=46)，观察组术中给予椎旁阻滞联合全麻，对照组仅给予全麻。观察两组患者术后应激反应和术后康复情况。结果:两组患者术前应激激素血管紧张素II(AngII)、C反应蛋白(CRP)、皮质醇、焦虑自我评分(SAS)等比较差异均无统计学意义(P>0.05)；术后24 h时观察组AngII显著低于对照组(P=0.001)，CRP显著低于对照组(P=0.000)，皮质醇显著低于对照组(P=0.009)；与对照组比较，观察组患者术后24 h时SAS评分显著降低(P=0.000)，视觉模拟评分显著降低(P=0.001)；肛门排气时间显著减短(P=0.002)；住院时间显著缩短(P=0.003)，术后引流时间、引流量比较两组间无差异性（P>0.05）。结论:椎旁阻滞联合全麻有助于降低结直肠癌患者术后应激反应，加速患者术后康复。