耻骨后顺行前列腺癌根治术与逆行根治术的围手术期情况和长期并发症比较  

Comparison of Outcomes and Complications between Antegrade and Retrograde Approach to Open Radical Prostatectomy

作　　者：熊子兵[1] 石明[1] Kunwar Ashok 陈铌[2] 张朋[1] 曾浩[1] 李响[1] 

机构地区：[1]四川大学华西医院泌尿外科,成都610041 [2]四川大学华西医院病理研究室,成都610041

出　　处：《四川大学学报（医学版）》2012年第1期95-98,103,共5页Journal of Sichuan University(Medical Sciences)

摘　　要：目的对比分析耻骨后顺行前列腺癌根治术与逆行根治切除术的围手术期情况和长期并发症。方法回顾性分析2006年4月至2011年5月接受开放性前列腺癌根治性切除术的76例患者的临床资料和随访结果,其中45例行耻骨后顺行前列腺癌根治术,31例行耻骨后逆行前列腺癌根治术,比较两组患者的围手术期情况和长期并发症发生率。结果 76例患者手术均获成功,无围手术期死亡病例,11例出现切缘阳性,顺行组5例,逆行组6例。术中出血(367.2±132.4)mL,其中顺行组出血(324.0±70.3)mL,逆行组出血(429.8±172.3)mL,差异具有统计学意义(P<0.05)。术后3例出现切口感染,顺行组1例(2.2%),逆行组2例(6.5%),两组间差异无统计学意义。随访2～63(32.56±18.25)月,无患者死于前列腺癌,4例生化复发。两组患者长期并发症(控尿情况、尿道狭窄和勃起功能障碍)发生率的差异无统计学意义。结论开放性前列腺癌根治术治疗局限性前列腺癌安全有效,顺行前列腺癌根治术较逆行前列腺癌根治术术中出血少。两种手术方式在围手术期情况和长期并发症上无明显差异。Objective To compare the operative outcomes and complications between an anterograde versus retrograde approach to open radical retropubic prostatectomy（RRP）;Methods Retrospectively analyze the clinical data and follow-up results of 76 prostate cancer patients who received radical retropubic prostatectomy from April 2006 to May 2011.According to the resection approach of prostate,the patients were divided into two groups,antegrade RRP group（45 cases） and retrograde RRP group（31 cases）.The operative outcomes and complications between two groups were analyzed.Results There was no peri-operative death and cancer specific death during the follow-up.Eleven cases were found positive surgical margin,5（11.1%） in antegrade group,6（19.3%） in retrograde group.The estimated blood loss of these 76 operations were 230-1200 mL（mean（367.2±132.4） mL）,（324.0±70.3） mL in antegrade group and（429.8±172.3） mL in retrograde group,respectively.The volume of blood loss between the two groups was significantly different.The durations of follow-up for the patients were 2-63 months（（24.22±13.21） months）,4 cases showed biochemical failure with criterion as prostate specific antigen 〉0.2 μg/L,2 patients had stress incontinence of antegrade RRP group and 1 patient had permanent incontinence of retrograde RRP group,there were no significant difference between the two groups.Conclusions Antegrade radical prostatectomy provides a low incidence of complications,reduced blood loss for localized prostatic cancer.

关 键 词：前列腺癌 逆行根治性前列腺切除术 并发症 

分 类 号：R737.25[医药卫生—肿瘤]