Porpiglia Francesco, Terrone Carlo, Tarabuzzi Roberto, Billia Michele, Grande Susanna, Musso Francesca, Burruni Rodolfo, Renard Julien, Scarpa Roberto Mario
Department of Urology, University of Turin, San Luigi Hospital, Orbassano, Torino, Italy.
Urology. 2006 Aug;68(2):376-80. doi: 10.1016/j.urology.2006.02.039.
To analyze, in a consecutive study, the perioperative, postoperative, and functional results of the transperitoneal and extraperitoneal approaches for laparoscopic radical prostatectomy.
A total of 160 patients underwent radical prostatectomy and were subdivided into two groups. Group 1 underwent the transperitoneal approach and group 2, the extraperitoneal approach. The preoperative parameters, age, prostate-specific antigen level, biopsy Gleason score, American Society of Anesthesiologists class, body mass index, and clinical stage, were considered. The perioperative parameters evaluated were the operative time, blood loss, blood transfusion, hospital stay, catheterization time, complications, histopathologic findings, TNM stage, Gleason score, prostate and tumor volumes, and functional results.
The patients in both groups had comparable preoperative data. No differences were observed between the two groups in the intraoperative data, except for the mean operative time (179 +/- 54.6 for group 1 versus 133.7 +/- 27 minutes for group 2). Also, no differences were observed between the two groups in terms of the postoperative data. The proportion of complications was 21.25% in group 1 and 22.5% in group 2. We recorded symptomatic lymphocele requiring treatment with a drain or reoperation in 8 patients (10%) in group 2 and 0% in group 1 (P <0.001) of all the patients who underwent lymphadenectomy. The rate of positive surgical margins was 25% for group 1 and 21.25% for group 2 (P = NS). For those with Stage pT2, the positive margin rate was 7.3% and 10% for groups 1 and 2, respectively. The recovery of continence at 3 months was faster in group 2 (75% of patients versus 50.9% in group 1; P <0.01).
The extraperitoneal approach required less operative time and enabled faster recovery of continence and the transperitoneal approach prevented the formation of lymphocele.
在一项连续性研究中，分析腹腔镜根治性前列腺切除术经腹腔和腹膜外途径的围手术期、术后及功能结果。
共有160例患者接受了根治性前列腺切除术，并被分为两组。第1组采用经腹腔途径，第2组采用腹膜外途径。考虑术前参数，包括年龄、前列腺特异性抗原水平、活检Gleason评分、美国麻醉医师协会分级、体重指数和临床分期。评估的围手术期参数包括手术时间、失血量、输血情况、住院时间、导尿时间、并发症、组织病理学结果、TNM分期、Gleason评分、前列腺和肿瘤体积以及功能结果。
两组患者术前数据具有可比性。除平均手术时间外（第1组为179±54.6分钟，第2组为133.7±27分钟），两组术中数据无差异。两组术后数据也无差异。第1组并发症发生率为21.25%，第2组为22.5%。在所有接受淋巴结清扫的患者中，我们记录到第2组有8例患者（10%）出现需要引流或再次手术治疗的有症状淋巴囊肿，而第1组为0%（P<0.001）。第1组手术切缘阳性率为25%，第2组为21.25%（P=无统计学意义）。对于pT2期患者，第1组和第2组切缘阳性率分别为7.3%和10%。第2组在3个月时控尿恢复更快（75%的患者，而第1组为50.9%；P<0.01）。
腹膜外途径手术时间较短，控尿恢复更快，而经腹腔途径可防止淋巴囊肿形成。
