单一中心3D/2D腹腔镜前列腺癌根治术的临床研究*

3D/2D laparoscopic radical prostatectomy: A single center experiences*

摘要:

目的??对比3D腹腔镜和2D腹腔镜下前列腺癌根治术（LRP）的临床疗效，总结LRP治疗早期前列腺癌的手术经验。方法 回顾性分析2015年11月-2016年4月于该科诊治的前列腺癌患者34例，观察组11例行3D LRP，对照组23例行2D LRP。对比分析两组手术时间、术中出血量、术后引流时间、术后24 h引流量、留置导尿管时间、住院时间、切缘阳性率、保留勃起功能成功率、术后1个月控尿率等指标及术后并发症情况。结果 所有手术均获成功。两组手术时间、术中出血量、术后引流时间、术后24 h引流量、留置导尿管时间、住院时间、切缘阳性率、保留勃起功能成功率、术后1个月控尿率和术后并发症情况差异均无统计学意义（均P >0.05）。观察组手术时间为（153.52±30.47）min，保留勃起功能成功率50.0%，术后出现4例尿失禁（36.4%），1例尿漏（9.1%），无切缘阳性和尿道狭窄，术后1个月控尿率为72.7%。对照组手术时间为（164.73±28.65）min，保留勃起功能成功率38.9%，术后出现13例尿失禁（56.5%），4例尿漏（17.4%），1例尿道狭窄（4.3%），2例切缘阳性（8.7%），术后1个月控尿率为60.9%。结论?LRP是治疗早期前列腺癌的一种安全、有效、微创的方法。3D LRP和2D LRP的治疗效果相当，但新型的3D腹腔镜系统在立体空间感和精细化操作方面更具有优势，值得临床推广应用。

Abstract:

Objective?To compare the clinical effect of 2D and 3D laparoscopic radical prostectomy and summarize surgical experience of laparoscopic radical prostectomy of early prostate cancer.?Methods?The clinical data of 34 cases of prostate cancer treated in our institute from November 2015 to April 2016 were collected and analyzed retrospectively. The patients in observation group (11 cases) were treated by 3D laparoscopic radical prostectomy, while those in control group (23 cases) were given 2D laparoscopic radical prostectomy. The operation time, intraoperative bleeding volume, postoperative drainage time, quantity of drainage fluid within 24 hours postoperatively, indwelling catheter time, hospital time, positive surgical margin rate, potence rate, 30d-urinary continence rate and complications were compared between the two groups.?Results?All operations were successfully performed. There were no significant differences in operation time, intraoperative bleeding volume, postoperative drainage time, quantity of drainage fluid within 24 hours postoperatively, indwelling catheter time, hospital time, positive surgical margin rate, potence rate, 30d-urinary continence rate and complications between the two groups (P > 0.05). In observation group, the operation time was (153.52 ± 30.47) min and the potence rate was 50.0 %, 4 cases with uroclepsia (36.4 %), 1 case with urine leakage (9.1 %), no patient had urethral stricture or positive surgical margin, the 30d-urinary continence rate was 72.7 %. In control group, the operation time was (164.73 ± 28.65) min and the potence rate was 38.9 %, 13 cases with uroclepsia (56.5 %), 4 cases with urine leakage (17.4 %), 1 case with urethral stricture (4.3 %), 2 cases with positive surgical margin (8.7 %), 30d-urinary continence rate was 60.9 %. ?Conclusion?Laparoscopic radical prostectomy is a safe, effective and less invasive method for treating early prostate cancer patients. Also 3D laparoscopic radical prostectomy play the similar functional results compared with 2D laparoscopic radical prostectomy, but 3D laparoscopic has the advantage in three dimensions space sense and accurate operation, it is worthy of promoting clinical application.