3D腹腔镜和传统腹腔镜前列腺根治性切除术的对比研究

发布时间：2018-07-29 19:59

【摘要】：[目的]前列腺癌(Prostate Cancer, PCa)是泌尿外科的常见恶性肿瘤之一,既往多运用传统二维(2-Dimentional,2D)腹腔镜技术进行PCa的根治性手术治疗。近年来随着三维(3-Dimentional,3D)成像技术在腹腔镜手术中的应用、发展及其所具有的优势,越来越多的前列腺根治性切除手术(Radical Prostatectomy, RP)采用3D腹腔镜技术辅助。本研究通过与传统2D腹腔镜RP的临床资料进行对比,评价3D腹腔镜RP的临床价值及安全性。[方法]回顾性分析山东大学齐鲁医院泌尿外科2015年1月至2016年1月期间因PCa行腹腔镜RP的45例患者的相关临床资料,其中包括3D腹腔镜手术组20例和传统2D腹腔镜手术组25例。所有患者术前均被经超声前列腺穿刺活检的病理结果证实为PCa。通过整理相关临床资料,我们对比研究了患者的一般人口学信息、术前血清前列腺特异性抗原(Prostate Specific Antigen, PSA)、手术时间、术中出血量、术后引流时间、胃肠蠕动恢复时间、术后住院天数、术后并发症情况、术后病理结果、住院总费用、术后相关治疗、术后随访3个月控尿情况及PSA生化变化,并通过问卷评分的方式评估了手术者的工作负荷、技术操作难度、画面清晰度及视觉舒适度以及护理人员手术配合的工作负荷等各项指标。采用SPSS 19.0软件进行统计学分析,计量资料的比较用独立样本t检验,计数资料的比较根据数据特点采用x2检验或Fisher精确概率计算,以P0.05为差异有统计学意义。[结果]两组患者的年龄、体重等一般人口学信息的差异均无统计学意义(P0.05)。所有45例手术均在全身麻醉下顺利实施,术中未改变手术方式。3D组患者平均手术时间为218.25±20.47min,2D组平均手术时间为254.20±40.25min,两者有显著统计学差异(P=0.080)。两组患者术中术后均未输血,3D组平均预估术中出血量为130.00±57.12mL,2D组平均术中出血量为194.00±119.30mL,3D组的平均术中出血量明显少于2D组,差异有统计学意义(P=0.041)。3D组术后引流时间为7.20±2.14天,短于2D组的术后引流时间9.92±3.11天,差异具显著统计学意义(P=0.028)。两组患者术中均未出现明显并发症,术后有部分患者出现吻合口漏及淋巴漏,其中3D组未出现无吻合口漏(0%)、1例淋巴漏(5%),2D组出现1例吻合口漏(4%)、4例淋巴漏(16%),差异不具统计学意义(P0.05)。对比两组的术后病理结果,切缘阳性率(15%vs.20%)与Gleason评分(7.12±1.18 vs.7.44±0.92)无显著统计学差异(P0.05)。对患者的随访研究显示,3D组患者术后3个月的满意控尿率显著高于2D组(85%vs.56%1 P=0.037)。在住院总费用上,3D组患者平均住院总费用为57217.91±7593.28元,2D组患者平均住院总费用为58829.73±11089.31元,无显著统计学差异(P=0.701)。对手术者而言,3D腹腔镜的工作负荷相比于2D腹腔镜更轻(3.55±0.52 vs.4.09±0.54),操作难度更低(3.36±0.50 vs.4.18±0.40),画面清晰度更高(4.64±0.50 vs.3.73±0.47),而视觉舒适度的差别不明显(3.91±0.70 vs.3.55±0.52)；护理人员认为3D腹腔镜的工作负荷与2D腹腔镜无显著差异(3.00±1.20 vs.3.13±0.83)。[结论]3D腹腔镜技术与传统2D腹腔镜技术相比,在RP中具有手术时间短、术中出血量少、术后引流时间及住院时间短、术后3个月控尿率高、手术者工作负荷低、手术操作难度低、图像清晰度高等优点,并具相当的安全性,适合在各级临床机构中广泛推广。
[Abstract]:[Objective] Prostate Cancer (PCa) is one of the common malignant tumors in the Department of urology. The traditional two dimensional (2-Dimentional, 2D) laparoscopy has been used to treat the radical operation of PCa. In recent years, with the application of the three-dimensional (3-Dimentional, 3D) imaging technology in the laparoscopic operation, the development and the advantages of the laparoscopic operation are increasing. The more radical resection of the prostate (Radical Prostatectomy, RP) was assisted by 3D laparoscopy. The clinical value and safety of the 3D laparoscopic RP were evaluated by comparison with the clinical data of the traditional 2D laparoscopic RP. [Methods] a retrospective analysis of the Department of Urology, Qilu Hospital, Shandong University from January 2015 to January 2016, was reviewed. The clinical data of 45 patients with PCa underwent laparoscopic RP, including 20 cases in the 3D laparoscopy group and 25 cases in the traditional 2D laparoscopy group. All the patients were confirmed by the pathological results of the ultrasound prostate biopsy before the operation. The general demographic information of the patients was compared to the general demographic information of the patients. Serum prostate specific antigen (Prostate Specific Antigen, PSA), operation time, intraoperative bleeding, postoperative drainage time, recovery time of gastrointestinal peristalsis, postoperative hospital days, postoperative complications, postoperative pathological results, total hospitalization expenses, postoperative related treatment, postoperative follow-up 3 months of urine control and biochemical changes of PSA, and through a questionnaire review The working load of the operator, the difficulty of technical operation, the clarity of the picture and the visual comfort and the working load of the nursing staff were evaluated by the method of SPSS 19. The statistical analysis was carried out by the software of the 19 software, the comparison of the data was compared with the independent sample t test, and the comparison of the count data was tested by the x2 test according to the characteristics of the data. Or Fisher accurate probability calculation, with P0.05 difference statistically significant. [results] the age, weight and other general demographic information of the two groups were not statistically significant (P0.05). All 45 cases were successfully implemented under general anesthesia, and the average operation time of the.3D group was 218.25 + 20.47min, and 2D group was flat. The average operation time was 254.20 + 40.25min, and there was significant difference between the two groups (P=0.080). The two groups had no blood transfusion during the operation, the average estimated bleeding amount in group 3D was 130 + 57.12mL, and the mean intraoperative bleeding amount in 2D group was 194 + 119.30mL. The mean intraoperative bleeding volume in group 3D was less than that of the 2D group, and the difference was statistically significant (P=0.041).3D group operation. The postoperative drainage time was 7.20 + 2.14 days, and the postoperative drainage time was 9.92 + 3.11 days shorter than the 2D group. The difference had significant statistical significance (P=0.028). There were no obvious complications in the two groups. Some of the patients had anastomotic leakage and lymphatic leakage, of which there was no anastomotic leakage (0%) in group 3D, 1 cases of lymphatic leakage (5%), and 1 cases in group 2D. Leakage (4%), 4 cases of lymphatic leakage (16%), the difference was not statistically significant (P0.05). Compared with the postoperative pathological results of the two groups, the positive rate of cutting edge (15%vs.20%) and Gleason score (7.12 + 1.18 vs.7.44 + 0.92) were not significantly different (P0.05). The follow-up study showed that the satisfactory rate of urinary control in group 3D patients was significantly higher than that of the 2D group (85%vs.56%1 P) at 3 months after operation (85%vs.56%1 P) =0.037). The average total hospitalization cost of patients in group 3D was 57217.91 + 7593.28 yuan, and the average total hospitalization cost in group 2D was 58829.73 + 11089.31 yuan, without significant statistical difference (P=0.701). For the operators, the operating load of 3D laparoscope was lighter (3.55 + 0.52 vs.4.09 + 0.54) than that of 2D (3.55 + 0.52 vs.4.09 + 0.54), and the difficulty of operation was lower (3.36 0.50 vs.4.18 + 0.40), the picture clarity was higher (4.64 + 0.50 vs.3.73 + 0.47), while the difference of visual comfort was not obvious (3.91 + 0.70 vs.3.55 + 0.52), and there was no significant difference between the working load of 3D laparoscopy and 2D laparoscopy (3 + 1.20 vs.3.13 + 0.83). [conclusion]3D laparoscopy was compared with traditional 2D laparoscopy, in RP It has short operation time, less bleeding in the operation, short time of postoperative drainage and hospitalization, high rate of urine control in 3 months after operation, low workload of the operation, low difficulty of operation, high definition of image, and considerable safety. It is suitable for extensive popularization in clinical institutions at all levels.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R737.25

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