改良单孔多通道腹腔镜前列腺癌根治术不同入路对患者免疫功能的影响  

Impacts of two different approaches of modified multichannel single-port laparoscopic radical prostatectomy on immune function in patients with prostate cancer

作　　者：王炳卫[1] 杨国胜[2] 邱晓拂[1] 王健富[1] 钟瑞伦[1] 刘百川[1] 李高远[1] 

机构地区：[1]广东省第二人民医院泌尿外科,广州市510317 [2]南方医科大学,广东省第二人民医院泌尿外科,广州市510515

出　　处：《实用医学杂志》2016年第13期2149-2152,共4页The Journal of Practical Medicine

基　　金：广东省医学科研基金(编号:B2014064)

摘　　要：目的:探讨改良单孔多通道腹腔镜前列腺癌根治术经腹腔或腹膜外入路治疗前列腺癌的临床疗效,及其对患者免疫功能的影响。方法:回顾性分析2012年1月至2015年12月采用改良单孔多通道腹腔镜手术治疗前列腺癌59例,其中经腹膜外入路(A组,39例),经腹腔入路(B组,20例)。经术前B超、CT或MRI和穿刺病理诊断为前列腺癌,临床分期均为T1-T2c,N0M0。评估两种术式的手术时间、术中出血量、肠功能恢复时间及术后住院时间,并检测患者手术前后血液的免疫指标:前列腺特异性抗原(TPSA、FPSA)、免疫球蛋白(IgG、IgA、IgM、C3、C4)及T淋巴细胞亚群(CD3^+、CD4^+、CD8^+、CD4^+/CD8^+)。结果:所有手术均顺利完成,无中转开放手术。A组手术时间、术中出血量、肠功能恢复时间、术后住院时间依次为(133.8±68.6)min、(75.6±51.3)mL、(2.2±0.7)d、(14.7±3.6)d,B组分别为(159.4±78.1)min、(102.2±70.8)mL、(2.9±1.1)d、(15.2±4.1)d;A组在减少出血量,缩短手术时间及肠功能恢复时间明显优于B组(P<0.05)。A组术后IgG、IgA、C3、C4、CD3^+、CD4^+、CD4^+/CD8^+明显高于B组(P<0.05);两组术后TPSA、FPSA、lg M水平,差异无统计学意义(P>0.05)。随访3~36个月,平均15个月,3例失访,随访患者无远期并发症,影像学检查未见肿瘤复发或转移。结论:与经腹腔入路相比,腹膜外入路改良单孔多通道腹腔镜前列腺癌根治术具有视野清晰,对腹腔器官影响小,手术时间短,术中出血少,术后恢复快等优点,更具有保护免疫功能的优势。Objective To explore the clinical efficacy of modified single-portlaparoscopic radical prostatec- tomy（LRP） by atransperitoneal or extraperitoneal approach, and the impact of either approach on immune function in patients with prostate neoplasms. Methods The clinical data on 39 patients who had undergoneextraperitoneal LRP（group A） and 20 patients who had reeeivedtranperitoneal LRP（group B） in our department from January 2012 to December 2015 were retrospectivelyanalyzed. The prostate neoplasms were preoperatively diagnosed as cancer by ultrasound, CT or MRI, and pathological examinations. The clinical stage was T1-T2c, NOM0 in all patients.The efficacy was assessed by surgical duration, intraoperative blood loss, timeto intestinal function recovery, and post- operative hospital stay in both groups. The indicators for immune function including prostate specific antigen （TPSA and FPSA）, immunoglobulin （IgG, IgA, lgM, C3, and C4） and T lymphocyte subsets （CD3^＋, CD4^＋, CD8^＋, CD4^＋ /CD8^＋） in patientswith prostate neoplasms before and after surgery were detected. Results 59 patients were operat-ed successfully, without converting to open approach. The mean surgical duration, blood loss, time to intestinal function recovery, and postoperative hospital stay were （133.8 ± 68.6） min, （75.6 ± 51.3） mL, （2.2 ± 0.7） days, and （14.7 ± 3.6） days in group A, while （159.4 ± 78.1） min, （102.2± 70.8） mL, （2.9 ± 1.1） days, and （15.2 ± 4.1） days in group B. There were significant differences between the two groups （P 〈 0.05）. After surgery, levels of IgG, IgA, C3, C4, CD3^＋, CD4^＋ and CD4^＋/CD8^＋ were significantly higherin group Athan in group B （P 〈 0.05）. There were no significant differences between the two groups in levels of TPSA, FPSA and lgM （P 〉 0.05）. Average postoperative follow-up was 15 months （range 3-36） in 36 patients. No recurrence or metastasis was found in all the patients by imaging studies,and no long-term

关 键 词：前列腺肿瘤 腹腔镜前列腺癌根治术 免疫功能 

分 类 号：R737.25[医药卫生—肿瘤]