腹腔镜前列腺癌根治术5年随访结果——中国单中心170例报道

目的探讨腹腔镜前列腺癌根治术(LRP)治疗局限性前列腺癌的中远期疗效。方法2000年10月至2005年2月由中山大学附属第三医院泌尿外科同一手术医师对连续170例局限性前列腺癌患者实施LRP。术后血清PSA水平连续2次≥0.2ng/ml定义为生化复发。控尿标准为站立或行走无尿液流出,或全天使用尿垫不超过1块。结果170例手术均获成功。手术时间平均240min,术中出血量平均100ml,拔尿管时间平均13d。主要并发症有:术中大出血1例,直肠损伤3例,输尿管损伤2例。术后切缘阳性率为24.1%,与病理分期和分级显著相关(P0.001,P0.001)。170例患者均获随访,随访时间60～112个月,平均71个月。5年无生化复发率为79.4%;在pT2,pT3a和pT3b期病例中,5年无生化复发率分别为84.9%,62.1%和76.9%。术后5年无生化复发率与切缘阳性率、病理分期、Gleason评分及术前PSA水平进行分层分析,差异均有显著性意义(P0.05)。拔尿管后129例(75.9%)控尿满意,术后1年163例(95.9%)控尿满意,5年后所有病例控尿满意。结论本研究报道国内随访时间最长的一组前列腺癌患者LRP术后情况表明,采用LRP治疗局限性前列腺癌安全可行,疗效满意。

Laparoscopic radical prostatectomy:oncological and functional results of 170 patients with a minimum 5-year follow-up

Objective To evaluate the oncological and functional results of the largest cohort of patients in China treated by laparoscopic radical prostatectomy （LRP） and with at least 5 years of follow-up. Methods From October 2000 to February 2005, 170 consecutive patients who had a LRP were retrospectively analyzed. All operations were performed by a single experienced surgeon （X.G.）. Biochemical progression was defined as a PSA level of ≥0.2 ng/mL at two consecutive time-points during follow-up after LRP. Urinary continence was defined as no pads or one diaper/24h by incontinence questionnaire. Resttlts The mean operative duration was 240 rain and blood loss 100 ml. Six patients had complications, including rectal injury （three）, ureteral injury （two）, active bleeding （one）. The overall positive surgical margin rate was 24.1% and correlated with pathological stage and Gleason score respectively （P〈0.001, P〈0.001 respectively）. All patients had ≥5 years of follow-up （range 60 - 112 months, mean 71）. At 5-year of follow-up, the biochemical progression-free survival was 79.4% in all patients. In all, 163 patients （95.9%） were continent at 1-year of follow-up and all patients were continent at 5-year of follow-up. Conclusions Our present series confirms that LRP is an effective, safe and precise technique at Chinese institution with excellent inter mediate-term oncological and functional results.