Hsu Elias I, Hong Eugene K, Lepor Herbert
Department of Urology, New York University School of Medicine, New York, New York 10016, USA.
Urology. 2003 Mar;61(3):601-6. doi: 10.1016/s0090-4295(02)02422-6.
To determine the influence of body weight and prostate volume on surgical outcomes after radical retropubic prostatectomy.
Between January 1994 and July 2000, 1024 men underwent radical retropubic prostatectomy by a single surgeon. Information was collected on body weight, prostate volume, operative time, estimated blood loss, allogenic transfusion rate, intraoperative complications, perioperative complications, postoperative complications, surgical margin status, and length of hospital stay. Postoperative continence and erectile function were assessed from self-administered questionnaires.
Body weight was not significantly related to operative time (P = 0.09), estimated blood loss (P = 0.12), allogenic transfusion rate (P = 0.49), intraoperative complications (P = 0.37), perioperative complications (P = 0.84), postoperative complications (P = 0.44), positive margin rate (P = 0.07), length of hospital stay (P = 0.27), postoperative continence (P = 0.72), or postoperative erectile function (P = 0.92). The prostate volume was significantly and directly related to the estimated blood loss (P = 0.02), allogenic transfusion rate (P = 0.01), and length of hospital stay (P = 0.01). The prostate volume was significantly and inversely related to the positive surgical margin rate (P = 0.03). The prostate volume was not significantly related to the operative time (P = 0.12), intraoperative complications (P = 0.68), perioperative complications (P = 0.73), postoperative complications (P = 0.14), postoperative continence (P = 0.23), or postoperative erectile function (P = 0.90).
No clinically relevant risks were associated with increasing body weight. Intraoperative bleeding resulting in higher transfusion rates represented the only clinically significant outcome that was adversely impacted by prostate volume. In the hands of experienced surgeons, radical retropubic prostatectomy can be performed in heavy men and in men with large prostates with excellent outcomes.
确定体重和前列腺体积对耻骨后根治性前列腺切除术后手术结果的影响。
1994年1月至2000年7月期间，1024名男性由同一位外科医生进行了耻骨后根治性前列腺切除术。收集了有关体重、前列腺体积、手术时间、估计失血量、异体输血率、术中并发症、围手术期并发症、术后并发症、手术切缘状态和住院时间的信息。通过自我填写问卷评估术后控尿和勃起功能。
体重与手术时间（P = 0.09）、估计失血量（P = 0.12）、异体输血率（P = 0.49）、术中并发症（P = 0.37）、围手术期并发症（P = 0.84）、术后并发症（P = 0.44）、切缘阳性率（P = 0.07）、住院时间（P = 0.27）、术后控尿（P = 0.72）或术后勃起功能（P = 0.92）均无显著相关性。前列腺体积与估计失血量（P = 0.02）、异体输血率（P = 0.01）和住院时间（P = 0.01）显著正相关。前列腺体积与手术切缘阳性率显著负相关（P = 0.03）。前列腺体积与手术时间（P = 0.12）、术中并发症（P = 0.68）、围手术期并发症（P = 0.73）、术后并发症（P = 0.14）、术后控尿（P = 0.23）或术后勃起功能（P = 0.90）均无显著相关性。
体重增加未带来临床上相关的风险。术中出血导致输血率升高是唯一受前列腺体积负面影响的具有临床意义的结果。在经验丰富的外科医生手中，耻骨后根治性前列腺切除术可在体重较重和前列腺较大的男性中进行，且效果良好。
