Artibani Walter, Grosso Gaetano, Novara Giacomo, Pecoraro Giuseppe, Sidoti Onofrio, Sarti Alessandra, Ficarra Vincenzo
Department of Urology, University of Verona, Verona, Italy.
Eur Urol. 2003 Oct;44(4):401-6. doi: 10.1016/s0302-2838(03)00315-4.
To compare morbidity in two groups of patients who underwent retropubic or laparoscopic radical prostatectomy in the same period.
The clinical and pathological data obtained in 50 consecutive patients who underwent retropubic radical prostatectomy (RRP) from January 2001 to December 2001 were compared to those obtained in 71 consecutive patients who were treated in the same year by extraperitoneal laparoscopic radical prostatectomy (LRP). The two groups were comparable in terms of mean pre-operative PSA and biopsy Gleason score. The peri-operative data included operative time, intra-operative and post-operative transfusion rates, complication rates, hospitalization length, and duration of catheterization. The following pathological parameters were considered: Gleason score, pathological stage, and positive surgical margin rate. A comparative evaluation of continence recovery (no pads and any leakage) was made only in patients with follow-up longer than 12 months.
The two groups were comparable in terms of pathological stage and definitive Gleason score. Operating times were significantly shorter in RRP (p<0.0001). LRP patients showed higher autologous (p<0.001) and eterologous transfusion (p=0.03). No significant difference was observed in terms of complication rates (p=0.07). The rectal injury rate was 2.8% in the laparoscopic group. The mean post-operative hospital stay was 10.2+/-2 days in the surgery group and 7.2+/-3.4 days in the laparoscopy group (p<0.001). Catheterization time was 8.4+/-0.9 days in the surgery group and 8+/-2.8 days in the laparoscopy group (p=0.27). After 12 months, complete continence was achieved in 64% of RRP and 40% of LRP patients, respectively (p=0.29).
The results of our non-randomized study show that up to now laparoscopic radical prostatectomy does not provide significant advantages in terms of peri-operative morbidity compared with the traditional retropubic approach.
比较同期接受耻骨后或腹腔镜根治性前列腺切除术的两组患者的发病率。
将2001年1月至2001年12月连续50例行耻骨后根治性前列腺切除术（RRP）患者的临床和病理资料，与同年71例行腹膜外腹腔镜根治性前列腺切除术（LRP）患者的资料进行比较。两组患者术前平均前列腺特异性抗原（PSA）水平和活检Gleason评分具有可比性。围手术期数据包括手术时间、术中及术后输血率、并发症发生率、住院时间和导尿时间。考虑以下病理参数：Gleason评分、病理分期和手术切缘阳性率。仅对随访时间超过12个月的患者进行控尿恢复（无需使用尿垫且无任何漏尿）的比较评估。
两组在病理分期和最终Gleason评分方面具有可比性。RRP组手术时间明显更短（p<0.0001）。LRP组患者自体输血率更高（p<0.001），异体输血率也更高（p=0.03）。并发症发生率方面未观察到显著差异（p=0.07）。腹腔镜组直肠损伤率为2.8%。手术组术后平均住院时间为10.2±2天，腹腔镜组为7.2±3.4天（p<0.001）。手术组导尿时间为8.4±0.9天，腹腔镜组为8±2.8天（p=0.27）。12个月后，RRP组和LRP组分别有64%和40%的患者实现完全控尿（p=0.29）。
我们的非随机研究结果表明，迄今为止，与传统耻骨后手术方法相比，腹腔镜根治性前列腺切除术在围手术期发病率方面未显示出显著优势。
