改良单孔多通道腹腔镜前列腺癌根治术不同入路对患者免疫功能的影响

发布时间：2018-06-16 05:36

本文选题：前列腺肿瘤 + 腹腔镜前列腺癌根治术　；参考：《实用医学杂志》2016年13期

【摘要】：目的:探讨改良单孔多通道腹腔镜前列腺癌根治术经腹腔或腹膜外入路治疗前列腺癌的临床疗效,及其对患者免疫功能的影响。方法:回顾性分析2012年1月至2015年12月采用改良单孔多通道腹腔镜手术治疗前列腺癌59例,其中经腹膜外入路(A组,39例),经腹腔入路(B组,20例)。经术前B超、CT或MRI和穿刺病理诊断为前列腺癌,临床分期均为T1-T2c,N0M0。评估两种术式的手术时间、术中出血量、肠功能恢复时间及术后住院时间,并检测患者手术前后血液的免疫指标:前列腺特异性抗原(TPSA、FPSA)、免疫球蛋白(IgG、IgA、IgM、C3、C4)及T淋巴细胞亚群(CD3~+、CD4~+、CD8~+、CD4~+/CD8~+)。结果:所有手术均顺利完成,无中转开放手术。A组手术时间、术中出血量、肠功能恢复时间、术后住院时间依次为(133.8±68.6)min、(75.6±51.3)mL、(2.2±0.7)d、(14.7±3.6)d,B组分别为(159.4±78.1)min、(102.2±70.8)mL、(2.9±1.1)d、(15.2±4.1)d;A组在减少出血量,缩短手术时间及肠功能恢复时间明显优于B组(P0.05)。A组术后IgG、IgA、C3、C4、CD3~+、CD4~+、CD4~+/CD8~+明显高于B组(P0.05);两组术后TPSA、FPSA、lg M水平,差异无统计学意义(P0.05)。随访3~36个月,平均15个月,3例失访,随访患者无远期并发症,影像学检查未见肿瘤复发或转移。结论:与经腹腔入路相比,腹膜外入路改良单孔多通道腹腔镜前列腺癌根治术具有视野清晰,对腹腔器官影响小,手术时间短,术中出血少,术后恢复快等优点,更具有保护免疫功能的优势。
[Abstract]:Objective: to investigate the clinical effect of modified single hole multichannel laparoscopic radical prostatectomy for prostate cancer through peritoneal or extraperitoneal approach and its effect on the immune function of patients. Methods: from January 2012 to December 2015, 59 cases of prostate cancer were treated by modified single-hole multi-channel laparoscopic surgery, including 39 cases of group A with extraperitoneal approach and 20 cases of group B with intraperitoneal approach. It was diagnosed as prostate cancer by CT or MRI and puncture pathology before operation, and the clinical stage was T _ 1-T _ 2C ~ (2) C ~ (2) N _ (0) M _ (0). The time of operation, the amount of blood lost during operation, the time of recovery of intestinal function and the time of hospitalization after operation were evaluated. The immunological parameters of the patients before and after operation were determined as follows: TPSAA FPSAA, IgGG, IgMN, C4) and T lymphocyte subsets CD8 ~ + CD8 ~ + / CD8 ~ +. Results: all the operations were completed successfully. The operative time, the amount of blood loss, the recovery time of intestinal function, and the postoperative hospitalization time were 133.8 卤68.6 min and 75.6 卤51.3 mL / min respectively in group B, which were 159.4 卤78.1 min, 102.2 卤70.8mL, 15.2 卤4.1 d, respectively. The shortening of operation time and the recovery time of intestinal function in group A were significantly better than those in group B (P 0.05). Group A was significantly higher than group B (P 0.05) in the level of IGG C _ (3) C _ (3) C _ (4) and C _ (4) T _ (4) and C _ (4) ~ / C _ (8), and there was no significant difference between the two groups in the level of TPSAN FPSAL M after operation. The patients were followed up for 3 ~ 36 months, with an average of 15 months. There were no long-term complications and no recurrence or metastasis were found in the imaging examination. Conclusion: compared with the transperitoneal approach, the modified single-hole multi-channel laparoscopic radical prostatectomy via extraperitoneal approach has the advantages of clear vision, less influence on abdominal organs, shorter operative time, less intraoperative bleeding, and faster recovery after operation. It has the advantage of protecting immune function.
【作者单位】：广东省第二人民医院泌尿外科;南方医科大学广东省第二人民医院泌尿外科;
【基金】：广东省医学科研基金(编号:B2014064)
【分类号】：R737.25

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