荧光腹腔镜与高清腹腔镜根治性前列腺切除术+扩大盆腔淋巴结清扫治疗局部高危前列腺癌的疗效对比  

Comparative study of fluorescence vs.high-definition laparoscopy in extended pelvic lymph node dissection plus radical prostatectomy for patients with locally advanced prostate cancer

作　　者：王喻[1] 温星桥[1] 李名钊[1] 黄群雄 李腾成[1] 肖楚天 刘小彭[1] 黄文涛[1] 陈征[1] 高新[1] Wang Yu;Wen Xingqiao;Li Mingzhao;Huang Qunxiong;Li Tengcheng;Xiao Chutian;Liu Xiaopeng;Huang Wentao;Chen Zheng;Gao Xin(Department of Urology,Third Affiliated Hospital,Sun Yat-Sen University,Guangzhou 510630,China)

机构地区：[1]中山大学附属第三医院泌尿外科,广州510630

出　　处：《中华泌尿外科杂志》2019年第3期161-166,共6页Chinese Journal of Urology

摘　　要：目的比较荧光腹腔镜根治性前列腺切除术(FLRP)与高清腹腔镜根治性前列腺切除术(HD-LRP)+扩大盆腔淋巴结清扫(ePLND)治疗局部高危前列腺癌(LAPCa)的疗效。方法前瞻性选取2015年7月至2018年4月我院收治的LAPCa患者进行研究。纳入标准:前列腺穿刺活检病理确诊为前列腺腺癌,Gleason评分均>7分;结合盆腔MRI或68Ga-PSMA-PET/CT等影像学资料,术前诊断临床分期≥cT3a期。排除标准:既往行内分泌治疗或化疗;术前影像学检查提示骨转移、远处淋巴结转移及内脏转移;拒绝手术;研究者认为的其他与治疗方案不符的情况。采用随机数字表法将患者分为研究组和对照组。研究组行FLRP+ePLND,术前30min在经直肠B超探头引导下,经会阴向前列腺两侧叶腺体内各注射5mg吲哚菁绿行淋巴造影,术中使用荧光探头,可见造影淋巴结呈绿色荧光,沿Eplnd区域行髂内、髂外、闭孔、骶前和髂总动脉旁淋巴结示踪清扫。对照组行HD-LRP+Eplnd,并增做骶前和髂总动脉旁淋巴结清扫。两组的根治性前列腺切除术方法相同。术后随访前列腺癌特异性抗原(PSA)和影像学检查,比较两组的手术时间、出血量、淋巴结清扫数量及阳性数量、并发症发生情况、生化复发率和2年无肿瘤转移生存率(MFSR)。结果本研究共纳入51例患者,研究组21例,对照组30例。研究组和对照组的年龄分别为(66.4±7.7)岁和(66.8±7.4)岁,体重指数分别为(24.3±1.5)kg/m^2和(25.1±1.5)kg/m^2,PSA分别为(23.5±16.8)ng/ml和(26.0±20.1)ng/ml,术前穿刺Gleason评分分别为(8.1±1.0)分和(7.9±0.9)分,差异均无统计学意义(P>0.05)。研究组和对照组的手术时间分别为(179±35)min和(205±46)min,Eplnd时间分别为(45.9±4.6)min和(56.4±3.2)min,清扫淋巴结数量分别为583枚和663枚,每例患者清扫淋巴结数量分别为(27.7±5.6)枚和(22.1±5.6)枚,差异均有统计学意义(P<0.05)。研究组和对照组淋巴结阳性例数分别�Objective To compare the efficacy of extended pelvic lymph node dissection(ePLND)and oncological outcome by fluorescence laparoscopic radical prostatectomy(FLRP)versus high-definition laparoscopic radical prostatectomy(HD-LRP)for men with locally advanced prostate cancer(LAPCa).Methods In a prospective trial,we recruited 51 patients with T3a-bNxM0 prostate cancer from July 2015 to April 2018.Patients were assigned to study group or control group according to random number method,and were underwent either FLRP+ePLND or HD-LRP+ePLND.21 in the study group were injected with 5 mg of indocyanine green(ICG)into the bilateral lobes of the prostate transperineally guiled by transrectal ultrasound 30 min before surgery for lymphography.During the surgical procedure a fluorescence laparoscope,optimized for detection in the near infrared range,was used to visualize the lymph nodes(green fluorescent)in the dissection region in the study group while a common laparoscopy introduced in control one.Lymph nodes were removed in the external iliac vessiles,internal iliac artery,obturator fossa regions,common iliac regions and presacral regions in both groups.Radical prostatectomy was completed in the both groups by similar steps.The operation time,blood loss,number of removed lymph nodes and positive lymph nodes,complication rate,biochemical recurrence(BCR)and metastasis free survival rates in 2 years were recorded and compared in the two groups.Results 51 eligible patients were selected,including 21 in the study group and 30 in the control group.The mean age of biopsy of study group and control one were(66.4±7.7)and(66.8±7.4),the mean age PSA(23.5±16.8)ng/ml and(26.0±20.1)ng/ml,the mean Gleason score of biopsy(8.1±1.0)and(7.9±0.9)respectively,and there was no statistical significant difference between two groups.The mean operation time of study group and control one were(45.9±4.6)min and(56.4±3.2)min,the mean removed lymph nodes were(27.7±5.6)and(22.1±5.6)respectively,and there was statistical significant difference betw

关 键 词：前列腺癌 扩大盆腔淋巴结清扫 荧光腹腔镜 吲哚菁绿 

分 类 号：R737.25[医药卫生—肿瘤]