Bhayani Sam B, Pavlovich Christian P, Hsu Thomas S, Sullivan Wendy, Su L i-Ming
James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
Urology. 2003 Mar;61(3):612-6. doi: 10.1016/s0090-4295(02)02416-0.
To evaluate and compare prospectively the convalescence of patients after laparoscopic radical prostatectomy (LRP) and open radical retropubic prostatectomy (RRP) in a standardized clinical care pathway at a single institution by two surgeons of equal experience and training.
The study included all 60 patients undergoing LRP and RRP by two fellowship-trained surgeons in their first year of practice. The postoperative care of these patients was uniform and standardized. The medical records were reviewed and convalescence data obtained by an independent urologist and physician's assistant.
Of the 60 patients, 24 underwent RRP and 36 underwent attempted LRP; 3 patients were converted from LRP to RRP. The differences in mean age, preoperative prostate-specific antigen level, Gleason score, in-hospital morphine equivalent requirement, time to oral intake, and hospital stay were not statistically significant between the LRP and RRP groups. The operating room time was significantly longer (5.8 +/- 1.2 hours versus 2.8 +/- 0.55 hours, P <0.0001) and the estimated blood loss was significantly lower in the LRP group (533 +/- 212 mL versus 1473 +/- 768 mL, P <0.0001) than in the RRP group. Pain medication use at home was significantly less in the LRP group (9 +/- 13 versus 17 +/- 15 oxycodone tablets, P <0.04), as was the time to complete convalescence (30 +/- 18 days versus 47 +/- 21 days, P <0.002).
Although LRP took almost twice as long to complete as RRP in our initial clinical experience, the patients had a similar hospital course. LRP patients required less pain medication after discharge and had a shorter time to complete recovery than did RRP patients. Additional studies are needed to address long-term cancer control, potency, and continence outcomes to determine the precise role of LRP in the treatment of men with clinically localized prostate cancer.
由两位经验和培训相当的外科医生，在单一机构的标准化临床护理路径下，对腹腔镜根治性前列腺切除术（LRP）和开放性耻骨后根治性前列腺切除术（RRP）后患者的康复情况进行前瞻性评估和比较。
该研究纳入了两位接受过专科培训的外科医生在其执业第一年进行LRP和RRP手术的所有60例患者。这些患者的术后护理是统一且标准化的。由一名独立的泌尿科医生和医师助理查阅病历并获取康复数据。
60例患者中，24例行RRP，36例行LRP尝试；3例患者由LRP转为RRP。LRP组和RRP组在平均年龄、术前前列腺特异性抗原水平、Gleason评分、住院期间吗啡等效需求量、开始经口进食时间和住院时间方面的差异无统计学意义。LRP组的手术时间明显更长（5.8±1.2小时对2.8±0.55小时，P<0.0001），估计失血量明显低于RRP组（533±212毫升对1473±768毫升，P<0.0001）。LRP组在家使用的止痛药物明显更少（9±13片对17±15片羟考酮片，P<0.04），完成康复的时间也更短（30±18天对47±21天，P<0.002）。
在我们最初的临床经验中，虽然LRP完成时间几乎是RRP的两倍，但患者的住院过程相似。LRP患者出院后所需止痛药物更少，完成康复的时间比RRP患者更短。需要进一步研究以探讨长期癌症控制、性功能和控尿结果，以确定LRP在临床局限性前列腺癌男性治疗中的确切作用。
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