前列腺癌根治术中避免手术切缘阳性的临床评价  

The Clinical Evaluation of How to Avoid Positive Surgical Margin in Prostate Cancer after Radical Prostatectomy

作　　者：邓京平[1] 钟晨阳[1] 万奔[1] 张传礼[1] 魏东[1] 邓庶民[1] 王建业[1] 

机构地区：[1]卫生部北京医院,100730

出　　处：《医学研究杂志》2008年第3期62-63,68,共3页Journal of Medical Research

摘　　要：目的探讨前列腺癌根治术中手术切缘阳性的临床意义,以及相关临床参数对手术切缘阳性率的影响。方法63例经病理证实的局限性前列腺癌实施前列腺根治术,通过回顾性研究了解病理分期、术前血清PSA、穿刺后Gleason评分、穿刺针数阳性百分率对手术切缘阳性的影响。结果63例前列腺癌病理分期T2a19例,切缘阳性1例;T2b11例,切缘阳性4例;T3a12例,切缘阳性0例;T3b8例,切缘阳性4例;T3c10例,切缘阳性5例。病理分期与手术切缘阳性成正相关(r=7.166,P=0.007),且对手术切缘阳性有意义(χ2=15.326,P=0.004)。本组偶发癌3例,切缘阳性1例。血清PSA异常63例,其中血清PSA<10ng/ml24例,术后切缘阳性4例,血清PSA>10ng/ml39例,术后切缘阳性12例,两者差异无显著性(χ2=2.236,P=0.135)。穿刺后Gleason评分60例,其中<7分40例,切缘阳性8例,>7分20例,切缘阳性7例,两者差异无显著性(χ2=1.600,P=0.206)。穿刺针数阳性百分率60例,其中<33%25例,切缘阳性3例,>33%35例,切缘阳性12例,两者差异有显著性(χ2=3.863,P=0.049)。结论血清PSA、穿刺后Gleason评分对前列腺癌根治术中切缘阳性无影响,而穿刺阳性百分率对手术切缘阳性有意义,同时手术者经验和手术技能对手术切缘阳性有一定影响。Objective We aimed to discuss the clinical significance of positive surgical margin after radical prostatectomy, as well as the relation between the relevant clinical parameters with the positive surgical margin rate. Methods we studied 63 patients with localized prostate cancer undergone radical prostatectomy, to access the impact of pathological stage, PSA, Gleason scores and positive percentage of the needle biopsy on the positive surgical margins. Results Within the 63 patients with prostate cancer, the pathologic stage of 19 patients are T2a , 1 of them has positive surgical margin; 11 patients are T2b, 4 positive; 12 patients are T3a, none of them has positive surgical margin; 8 patients are T3b, 4 positive; 10 patients are T3c, of them 5 patients have positive margin. We found positive correlation （r = 7. 166, P = 0. 007 ） between pathologic staging and positive surgical margin, and the result is meaningful （Х^2 = 15. 326, P = 0. 004）. The group include 3 patients with sporadic cancer, 1 of them have positive margin. The serum PSA of all the 63 patients are abnormal, 24 patients serum PSA 〈 10ng/ml, of them 4 have positive margin ; 39 case serum PSA 〉 10ng/ml s, 12 of them positive; there was no significant difference（Х^2= 2. 236, P = 0. 135） observed. Gleason score of 60 cases, of which 40 cases have scores 〈 7, 8 cases have positive margin; 20 cases have scores 〉 7, 7 cases have positive margin, there was no significant difference （Х^2 = 1. 600, P = 0. 206） observed. We also studied the positive percentage of the needle biopsy of the 60 cases, of which 25 cases have a positive rate 〈 33% , 3 cases have positive margin; 35 cases have a positive rate 〉 33% , 12 cases have positive margin, the difference was significant （Х^2 = 3. 863, P = 0. 049）. Conclusions There is no significant positive impact of PSA or Gleason score to the positive surgical margin of patients with prostate cancer undergone radical resection. The positive percentage of the needle biopsy has a signifi

关 键 词：前列腺癌 前列腺根治术 预后 手术技能 

分 类 号：R737.25[医药卫生—肿瘤] R733.3[医药卫生—临床医学]