前列腺穿刺术后不同时机行腹腔镜前列腺癌根治术的效果与安全性的前瞻性随机对照研究  

A prospective randomized controlled study on the efficacy and safety of laparoscopic radical prostatectomy at different time points after prostate biopsy

作　　者：韩广业[1] 马阔 宋伟航 刘沛[1] 张少华 余沁楠[1] HAN Guang-ye;MA Kuo;SONG Wei-hang;LIU Pei;ZHANG Shao-hua;YU Qin-nan(Department of Urology,the First Affiliated Hospital of Xinxiang Medical University,Xinxiang 453100,Henan,CHINA)

机构地区：[1]新乡医学院第一附属医院泌尿外科,河南新乡453100

出　　处：《海南医学》2024年第16期2320-2324,共5页Hainan Medical Journal

基　　金：河南省医学科技攻关计划联合共建项目(编号:LHGJ20220607)。

摘　　要：目的探究前列腺穿刺术后不同时机行腹腔镜前列腺癌根治术(LRP)对治疗效果的影响。方法前瞻性选取2022年1月至2023年8月新乡医学院第一附属医院收治的165例前列腺癌(PCa)患者作为研究对象,按照随机数表法分为超早期组、早期组、晚期组各55例。超早期组于前列腺穿刺术后7 d内行LRP,早期组于前列腺穿刺术后6周内行LRP,晚期组于前列腺穿刺术后6~8周行LRP。比较三组患者的切缘阳性率、手术相关指标以及术前和术后1 d、3 d的创伤指标[C反应蛋白(CRP)、白细胞介素-6(IL-6)],术前与术后7 d的尿流动力学[最大尿流率状态下逼尿肌压力(Pdetat Q_(max))、残余尿量(PVR)、最大尿流率(Q_(max))],术前与术后3个月、6个月的肿瘤因子[血管内皮生长因子(VEGF)、转化生长因子-β_(1)(TGF-β_(1))、前列腺特异性抗原(PSA)]水平,术后3个月、6个月的尿失禁和勃起功能异常率。结果三组患者的切缘阳性率与手术相关指标比较差异均无统计学意义(P>0.05);术后1 d,超早期组患者的CRP和IL-6水平分别为(12.25±1.68)mg/L、(33.18±6.22)ng/L,明显高于早期组的(10.71±1.41)mg/L、(28.51±5.19)ng/L和晚期组的(10.53±1.25)mg/L、(28.39±5.37)ng/L,差异均有统计学意义(P<0.05);三组患者术后7 d的尿流动力学比较差异无统计学意义(P>0.05);三组患者术后3个月、6个月的血清PSA、TGF-β_(1)、VEGF水平、术后尿失禁、勃起功能异常率比较差异均无统计学意义(P>0.05)。结论前列腺穿刺术后不同时机行LRP对手术效果无明显影响,但穿刺术后越早手术机体的创伤应激越明显,实践中需根据患者耐受力合理选择手术时机。Objective To investigate the effect of laparoscopic radical prostatectomy(LRP)at different time points after prostate biopsy on the therapeutic effect.Methods A total of 165 patients with prostate cancer(PCa)admitted to the First Affiliated Hospital of Xinxiang Medical College from January 2022 to August 2023 were prospectively selected and randomly divided into three groups according to a random number table:ultra-early group,early group,and late group,with 55 cases in each group.Patients in the three groups underwent LRP within 7 days after prostate biopsy,within 6 weeks after prostate biopsy,and within 6-8 weeks after prostate biopsy,respectively.The positive rate of operation margins and operation related indicators,as well as trauma indicators[C-reactive protein(CRP),interleukin-6(IL-6)]before operation and at 1 day and 3 days after operation,urodynamic parameters[maximum flow rate detrusor pressure(Pdetat Q_(max)),post-void residual urine volume(PVR),maximum flow rate(Q_(max))]before operation and at 7 days after operation,tumor factor levels[vascular endothelial growth factor(VEGF),transforming growth factor-β_(1)(TGF-β_(1)),prostate specific antigen(PSA)]before operation and at 3 months and 6 months after operation,and urinary incontinence and erectile dysfunction rates at 3 months and 6 months after surgery were compared among the three groups.Results There was no significant difference in the positive rate of surgical margins and other operation-related indicators among the three groups of patients(P>0.05).One day after operation,the levels of CRP and IL-6 in the ultra-early group were(12.25±1.68)mg/L and(33.18±6.22)ng/L,respectively,which were significantly higher than(10.71±1.41)mg/L and(28.51±5.19)ng/L in the early group and(10.53±1.25)mg/L and(28.39±5.37)ng/L in the late group(P<0.05).There was no significant difference in urodynamics among the three groups at 7 days after operation(P>0.05).There was no significant difference in serum PSA,TGF-β_(1),VEGF levels,postoperative urinary incontin

关 键 词：前列腺癌 穿刺术 前列腺癌根治术 腹腔镜 手术时机 尿流动力学 肿瘤因子 尿失禁 勃起功能 

分 类 号：R737.25[医药卫生—肿瘤]