腹腔镜下前列腺癌根治术经膀胱前入路与膀胱后入路疗效比较

目的 探讨腹腔镜下前列腺癌根治术(LRP)经膀胱前入路与膀胱后入路的优缺点.方法 回顾分析59例LRP围手术期资料和术后肿瘤学及排尿功能情况.患者平均年龄66岁.均经穿刺活检诊断为前列腺癌,TNM分期为T1c～T3b,Gleason评分3～8.分为膀胱后入路组25例,膀胱前入路组34例.2组患者年龄、体质量指数、PSA值、Gleason评分差异无统计学意义.统计学分析比较2组患者术前、术中和术后临床参数和并发症发生率、术后肿瘤学和排尿状况. 结果 59例手术均获成功.后入路和前入路2组患者术中平均出血量分别为(642.0±552.7)和(637.1±370.8)ml、并发症发生率分别为4.0%和2.9%、切缘阳性率分别为24.0%和20.6%.2组患者术后3个月控尿率分别为72%和88%、6个月控尿率分别为88%和91%,差异均无统计学意义(P>0.05).前入路组平均前列腺切除时间(174.2±58.0)min,后入路组(224.85±66.7)min,差异有统计学意义(P<0.01).前入路组术后平均恢复时间(5.9 d)与后入路组(7.5 d)比较差异有统计学意义(P<0.05). 结论 LRP经膀胱前入路较膀胱后入路前列腺切除时间和术后恢复时间短,具有临床应用优势.

Laparoscopic radical prostatectomy: transperitoneal anterior bladder approach versus transperitoneal pos-terior bladder approach

Objective To compare perioperative parameters, as well as the oncological and func-tional results, for laparoscopic radical prostatectomy (LRP) performed via the posterior bladder and anterior bladder approaches. Methods The recorded pre-, peri-, and postoperative parameters and complications, and evaluated the oncological and functional results were collected and compared be-tween the posterior bladder approach (n=25) and the anterior bladder approach (n=34). Results There were no significant differences regarding the preoperative characteristics of the two groups. The mean blood loss, complications, positive surgical margins, and continence showed no significant differences between the 2 groups at 3 and 6 months postoperatively. The mean operation time was sig-nificantly shorter in anterior bladder approach group (174.2±58. 0 min) than in posterior bladder ap-proach group (224. 8±66.7 rain), (P<0. 01). Also, the postoperative recovery time until discharge was 5.9 d in anterior bladder approach group, which was significantly shorter than in posterior bladder approach group (7.5 d) (P<0.05). Conclusion The anterior bladder approach yields shorter oper-ation time and postoperative recovery period than posterior bladder approach for LRP.