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目的比较经腹膜外途径三孔法3D腹腔镜与2D腹腔镜下前列腺癌根治术的近期临床疗效。方法回顾性分析2014年1月至2015年12月共31例行三孔法腹膜外途径腹腔镜下前列腺癌根治术患者的临床资料,所有手术均为同一人主刀完成,其中3D腹腔镜组16例,病例来自上海市第一人民医院;2D腹腔镜组15例,病例来自嘉兴市第一医院。对比两组的手术时间,保留性神经,术中出血量,术后住院天数,手术切缘阳性率,术后生化复发率,术后尿失禁发生率等指标的差异。结果 31例前列腺癌根治术均在腹腔镜下完成。其中3D腹腔镜组均成功采用三孔法;2D腹腔镜组采用三孔法完成13例,2例中转五孔法完成。3D腹腔镜组手术时间为55~125 min,平均88 min;尿道吻合时间5~18min,平均10 min;术中出血20~200 ml,平均60 ml;术后轻度尿失禁2例(12.5%);术中保留性神经8例(50.0%);切缘阳性1例(阳性率6.3%)。2D腹腔镜组手术时间为80~180 min,平均105 min;尿道吻合时间10~26 min,平均15 min;术中出血30~400 ml,平均105 ml;术后轻度尿失禁3例(23.1%);术中保留性神经4例(30.8%);切缘阳性3例(23.1%)。31例术后病理均证实为前列腺癌,Gleason评分5~9分。术后随访4~25个月,其中4例生化复发,3D和2D腹腔镜组各2例。结论与2D相比3D腹腔镜三孔法前列腺癌根治术的解剖层次更清晰、缝合更精准、操作更简便。三孔法3D腹腔镜前列腺癌根治术具有较高的安全性和可行性。
Objective To compare the short-term clinical effects of three-hole extraperitoneal approach with 3D-laparoscopy and 2D laparoscopic radical prostatectomy. Methods The clinical data of 31 patients who underwent laparoscopic radical prostatectomy with three-hole peritoneal approach from January 2014 to December 2015 were retrospectively analyzed. All operations were performed by the same surgeon, of which 3D laparoscopic group 16 Cases, cases from Shanghai First People’s Hospital; 2D laparoscopic group of 15 cases, the case from Jiaxing First Hospital. The difference of operation indexes such as operation time, reserved nerve, intraoperative blood loss, postoperative hospital stay, surgical margin positive rate, postoperative biochemical recurrence rate and postoperative urinary incontinence rate were compared. Results All 31 cases of radical prostatectomy were performed under laparoscopy. Three-hole method was successfully used in 3D laparoscopic group, 13 cases in 2D laparoscopic group and three cases in 5 cases. In the 3D laparoscopic group, the operation time was 55-125 min (average 88 min); the anastomotic urethra time was 5-18 min (mean 10 min); the intraoperative bleeding was 20-200 mL (average 60 ml); postoperative mild urinary incontinence was 2 ); 8 cases of intraoperative preserving nerve (50.0%); 1 case of positive margins (positive rate 6.3%). The operation time of 2D laparoscopic group was 80-180 min (mean 105 min). The anastomotic urethra time ranged from 10 to 26 min (mean 15 min). The intraoperative bleeding ranged from 30 to 400 mL with an average of 105 mL. Postoperative mild urinary incontinence occurred in 3 patients (23.1 %). There were 4 cases (30.8%) of reserved nerves in operation and 3 cases (23.1%) of positive margins. 31 cases of postoperative pathology were confirmed as prostate cancer, Gleason score 5 to 9 points. The patients were followed up for 4 to 25 months, of which 4 were biochemical recurrences and 2 were in the 3D and 2D laparoscopic groups. Conclusion Compared with 2D, 3D laparoscopic radical prostatectomy has a clearer anatomy level, more accurate suture and easier operation. Three-hole 3D laparoscopic radical prostatectomy has high safety and feasibility.