摘要
目的:探讨经会阴前列腺穿刺活检(TPPB)在前列腺癌腹腔镜手术中的应用效果及安全性.方法:回顾性选取2020年3月至2022年8月解放军联勤保障部队第910医院收治的前列腺癌患者106例,按照手术方案不同将其分为经会阴组和经直肠组,每组53例.经会阴组行TPPB,经直肠组行经直肠前列腺穿刺活检术(TRPB),两组均行前列腺癌腹腔镜手术.比较两组病灶完全切除率、手术指标、围术期创伤应激激素[促肾上腺皮质激素(ACTH)、皮质醇(Cor)、醛固酮(ALD)]、前列腺特异性抗原(PSA)、术后病理Gleason评分、手术前后生存质量[前列腺癌症状评分表(EPCI)]及并发症发生情况.统计学方法采用t检验、χ2 检验和Ridit检验.结果:两组病灶完全切除率、分离前列腺尖部时间、住院时间、术后切缘阳性率、术后并发症发生率比较差异均无统计学意义(P值分别为 1.000、0.597、0.182、0.713、0.540);术后血清PSA水平较术前下降(P<0.001),但组间比较差异无统计学意义(P>0.05).与经直肠组比较,经会阴组手术时间、分离直肠前间隙时间短,术中失血量少(t值分别为 14.034、24.953、11.605,P均<0.001),术中严重黏连率低(χ2=8.774,P=0.003),术后病理Gleason评分优(U=2.489,P=0.013),差异均有统计学意义.两组术后12、24、48 h血清ACTH、Cor、ALD水平均较术前升高(P均<0.001),经会阴组均低于经直肠组(P均<0.001);术后 3个月两组EPCI量表中泌尿功能、肠道功能、激素功能、性功能评分均较术前升高(P均<0.001),经会阴组均高于经直肠组(P均<0.001).结论:与经直肠穿刺相比,TPPB术后行前列腺癌腹腔镜手术可能会缩短手术时间,减少术中失血量及术中严重黏连,减轻创伤程度,生存质量较高,也不会增加并发症.
Abstract
Objective:To investigate the efficacy and safety of transperineal prostate biopsy(TPPB)in laparo-scopic prostatectomy for prostate cancer.Methods:A retrospective study was conducted on 106 prostate cancer pa-tients admitted to the No 910 Hospital Affiliated to Joint Logistic Support Force of PLA from March 2020 to August 2022 were divided into transperineal group and transrectal group according to different surgical protocols,with 53 cas-es in each group.Both groups underwent laparoscopic prostatectomy,with the transperineal group undergoing TPPB and the transrectal group undergoing transrectal prostate biopsy(TRPB).The complete resection rate of the lesion,surgical indicators,perioperative trauma stress hormones[adrenocorticotropic hormone(ACTH),cortisol(Cor),al-dosterone(ALD)],prostate specific antigen(PSA),postoperative pathological Gleason score,pre-and post-opera-tive quality of life[prostate cancer symptom score scale(EPCI)],and complications were compared between the two groups.Statistical methods used were t-test,χ2 test,and Ridit test.Results:There were no significant differenc-es in the complete resection rate of the lesion,time to separate the apex of the prostate,length of hospital stay,posi-tive rate of incisal margin,and incidence of postoperative complications between the two groups(P values were 1.000,0.597,0.182,0.713,and 0.540,respectively).The postoperative serum PSA levels in both groups de-creased compared with those before surgery(P<0.001),but there was no significant difference between the groups(P>0.05).Compared with the transrectal group,the transperineal group had shorter operation time and time to sepa-rate the anterior rectal space,less intraoperative blood loss(t values were 14.034,24.953,and 11.605,respectively,all P<0.001),lower rate of severe adhesion during surgery(χ2=8.774,P=0.003),and better postoperative patho-logical Gleason score(U=2.489,P=0.013),all with statistically significant differences.The levels of serum ACTH,Cor,and ALD in both groups increased significantly at 12,24,and 48 hours after surgery(all P<0.001),and were lower in the transperineal group than in the transrectal group(all P<0.001).At 3 months after surgery,the scores of urinary function,intestinal function,hormonal function,and sexual function in the EPCI scale increased sig-nificantly in both groups compared with those before surgery(all P<0.001),and were higher in the transperineal group than in the transrectal group(all P<0.001).Conclusion:Laparoscopic surgery for prostate cancer after TPPB can shorten the operation time,reduce intraoperative blood loss and severe adhesions,reduce the degree of trauma,and have a lower risk of pathological progression,higher quality of life,and no increased complications.
基金项目
2020年福建省卫生健康科技计划项目资助计划项目(2020QNA280)
NETL
NSTL
万方数据