腹腔镜前列腺癌根治术和开放根治术的临床对照研究

发布时间：2018-06-04 06:25

本文选题：前列腺癌 + 根治术　；参考：《中南大学》2014年硕士论文

【摘要】：目的通过对比开放前列腺癌根治术(Retropubic radical prostatectomy,RRP)与腹腔镜前列腺癌根治术(Laparoscopic radical prostatectomy,LRP)两种不同手术方式的围手术期并发症及临床疗效,评价腹腔镜前列腺癌根治术治疗局限性前列腺癌的手术安全性及临床价值。方法回顾分析中南大学湘雅二医院泌尿外科于2009年1月至2013年10月期间行前列腺癌根治手术的患者89例,其中行RRP52例,行LRP37例,分别比较两种术式的术前年龄、术前Gleason评分、术前临床分期、术中出血量、手术时间、术后疼痛评分、术后通气时间、留置导尿时间、围手术期并发症、术后住院天数、术后1年尿控率、切缘阳性率等各项指标。结果两组手术均顺利完成,LRP组无病例需中途转开放。LRP组与RRP组术中平均出血量分别为(314±201)ml与(785±526)ml,两者间具有显著性差异(p0.01);LRP组手术时间为(236±131)min,与RRP组平均手术时间(1924±105)min(p0.01),对于中高危需行盆腔淋巴结清扫术的患者,其手术时间分别平均另需62分钟和47分钟；术后疼痛评分LRP组与RRP组分别为(2.37±1.89)与(3.46±1.53)(p0.05)；平均术后通气时间LRP与RRP分别为(65±16)h与(69±21)h(p0.05)；术后留置导尿时间分别为LRP组(13.84±2.68)d与RRP组(14.25±3.62)d(p0.05)；平均术后住院天数分别为(11.6±4.3)d与(14.5±6.2)d(p0.05)；术后1年尿控率分别为90.3%(28/31)与88.1%(37/42)(p0.05)；切缘阳性率分别为27%(10/37)与23.1%(12/52)(p0.05)。结论腹腔镜前列腺癌根治术比开放手术具有微创、出血少、恢复快等优势,而术后尿失禁、切缘阳性率及围手术期并发症的发生率与开放术相似,LRP治疗局限性前列腺癌是安全可靠的。
[Abstract]:Objective to compare the perioperative complications and clinical efficacy between open radical prostatectomy and laparoscopic radical prostatectomy for prostate cancer. To evaluate the safety and clinical value of laparoscopic radical prostatectomy for localized prostate cancer. Methods A retrospective analysis was made on 89 patients undergoing radical prostatectomy in the Department of Urology, Xiangya second Hospital, Central South University, from January 2009 to October 2013, including RRP52 and LRP37. The preoperative age and preoperative Gleason score of the two operations were compared. Clinical stage, intraoperative bleeding volume, operative time, postoperative pain score, postoperative ventilation time, indwelling time, perioperative complications, postoperative hospitalization days, postoperative urinary control rate, positive rate of incision margin, and so on. Results the average intraoperative blood loss in the LRP-free group and the RRP group was 314 卤201)ml and 785 卤526ml, respectively. There was significant difference between the two groups. The operative time of the LRP-free group was 236 卤131 minutes, and that of the RRP group was 1924 卤105 minutes. Patients with middle and high risk requiring pelvic lymph node dissection, The average operation time was 62 minutes and 47 minutes respectively. The postoperative pain scores of LRP group and RRP group were 2.37 卤1.89 and 3.46 卤1.53, respectively; the mean postoperative ventilation time of LRP and RRP were 65 卤16 hours and 69 卤21 h respectively; the time of postoperative indwelling catheterization were 13.84 卤2.68 days in LRP group and 14.25 卤3.62 days in RRP group; the average postoperative hospitalization days were 11.6 卤4.3 days and 14.5 卤6.2 days (p0.05) respectively, and the duration of postoperative indwelling urinary catheterization were 13.84 卤2.68 days in LRP group and 14.25 卤3.62 days in RRP group respectively, and the average postoperative hospitalization days were 11.6 卤4.3 days and 14.5 卤6.2 days (p0.05), respectively, one year after operation, the postoperative indwelling time was 13.84 卤2.68 days in LRP group and 14.25 卤3.62 days in RRP group. The urinary control rates were 90.33% and 88.1T / 42, respectively, and the positive rates of the incision margin were 27 / 10 / 37) and 23.1% / 52% respectively. Conclusion Laparoscopic radical prostatectomy has the advantages of minimally invasive, less bleeding and faster recovery than open prostatectomy, while postoperative urinary incontinence. The positive rate of incision margin and the incidence of perioperative complications are similar to those of open surgery. LRP is safe and reliable in the treatment of localized prostate cancer.
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.25

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