Rassweiler Jens, Schulze Michael, Teber Dogu, Seemann Othmar, Frede Thomas
Department of Urology, Klinikum Heilbronn, University of Heidelberg, Am Gesundbrunnen 20, D-74074 Heilbronn, Germany.
Curr Opin Urol. 2004 Mar;14(2):75-82. doi: 10.1097/00042307-200403000-00005.
Laparoscopic radical prostatectomy has become an accepted alternative to open surgery, however data on the functional and oncological outcome are still lacking. In this study we present an analysis based on a survey of the current literature and the first 500 patients treated with the Heilbronn technique. Additionally, we compare the results of laparoscopy with those of open radical prostatectomy.
We conducted an extensive MEDLINE search of laparoscopic and open radical prostatectomy from 1999 through 2003, focusing on the last 3 years. The articles as well as our own results were analyzed with respect to continence, potency, positive margins, prostatic specific antigen failure, and clinical progression. No significant differences were found between the laparoscopic and open approach with respect to overall continence at 12 months (60-94% versus 61-98%) or at 3 months (51-63% versus 62-69%), varying from 4.1% at pT2, 12% at pT3 to 19% at pT4 stages. We found no significant differences between the two techniques in the recovery of potency (34-67% versus 31-79%), if one excludes the selected series of Walsh with a mean age of 57 years. Furthermore, we did not detect any significant differences in positive margins and short-term prostatic specific antigen recurrence (3 years).
At centers of expertise, laparoscopic radical prostatectomy is able to provide similar functional and oncological results as its open counterpart, however with the advantages of minimally invasive surgery.
腹腔镜根治性前列腺切除术已成为开放性手术可接受的替代方法，然而关于其功能和肿瘤学结局的数据仍然缺乏。在本研究中，我们基于对当前文献的调查以及采用海尔布隆技术治疗的首批500例患者进行分析。此外，我们将腹腔镜手术结果与开放性根治性前列腺切除术的结果进行比较。
我们对1999年至2003年期间的腹腔镜和开放性根治性前列腺切除术进行了广泛的MEDLINE检索，重点关注最近3年。对文章以及我们自己的结果进行了关于控尿、性功能、切缘阳性、前列腺特异性抗原失败和临床进展方面的分析。在12个月时（60 - 94%对61 - 98%）或3个月时（51 - 63%对62 - 69%），腹腔镜手术和开放性手术在总体控尿方面未发现显著差异，在pT2期为4.1%，pT3期为12%，pT4期为19%。如果排除平均年龄为57岁的沃尔什所选系列病例，我们发现两种技术在性功能恢复方面无显著差异（34 - 67%对31 - 79%）。此外，我们未检测到切缘阳性和短期前列腺特异性抗原复发（3年）方面的任何显著差异。
在专业中心，腹腔镜根治性前列腺切除术能够提供与开放性手术相似的功能和肿瘤学结果，但具有微创手术的优势。
