肥胖与内镜下腹膜外根治性前列腺切除术的手术效果及功能转归：500例患者的评估

Performance and functional outcome of endoscopic extraperitoneal radical prostatectomy in relation to obesity: an assessment of 500 patients.

作者信息

Liatsikos Evangelos, Mühlstädt Sandra, Kallidonis Panagiotis, Rabenalt Robert, Do Minh, Burchardt Martin, Herrmann Thomas R, Stolzenburg Jens-Uwe

机构信息

Department of Urology, University of Patras, Greece.

出版信息

BJU Int. 2008 Sep;102(6):718-22. doi: 10.1111/j.1464-410X.2008.07664.x. Epub 2008 Apr 16.

DOI:10.1111/j.1464-410X.2008.07664.x

PMID:18422768

Abstract

OBJECTIVE

To investigate the impact of obesity on the performance and functional outcome of endoscopic extraperitoneal radical prostatectomy (EERPE).

PATIENTS AND METHODS

We retrospectively examined 500 patients treated with EERPE; they were categorized into three groups according to the World Health Organization classification of obesity: normal weight (body mass index, BMI, <25.0 kg/m(2)), overweight (25.0-29.9 kg/m(2)) and obese (30.0 kg/m(2)). The database of our institution was reviewed and perioperative data evaluated. The functional data were collected through questionnaires before and after EERPE and analysed statistically.

RESULTS

The age, prostate size and preoperative PSA level were similar in all three groups. The mean (sd) BMI was 27 (3.3) kg/m(2), with 26.8%, 56.6% and 16.6% of the patients classed as normal, overweight and obese, respectively. A pelvic lymph node dissection and nerve-sparing was done in 218 and 123 patients, respectively. There was no statistically significance difference in the number of patients in each group who had previous procedures. Obese patients had a significantly higher American Society of Anesthesiologists score. The mean operative duration for all patients was 149 min; there was a statistically significant difference in duration among the three groups, with EERPE or nerve-sparing EERPE requiring a mean of 20 min more in obese patients. There was no conversion to open surgery. The estimated mean blood loss was 200 mL; four patients, none of them in the obese group, received a blood transfusion. At 3 months after EERPE there was a trend to worse continence in obese patients, but it was not statistically significant, and was not apparent at 6 months. There was no difference in transfusion rate and duration of catheterization.

CONCLUSION

EERPE seems to be a feasible and reproducible surgical technique in obese patients, although the operation takes longer.

摘要

目的

探讨肥胖对内镜下腹膜外根治性前列腺切除术（EERPE）手术效果及功能结局的影响。

患者与方法

我们回顾性研究了500例行EERPE治疗的患者；根据世界卫生组织的肥胖分类将他们分为三组：正常体重（体重指数，BMI，<25.0 kg/m²）、超重（25.0 - 29.9 kg/m²）和肥胖（≥30.0 kg/m²）。查阅了我们机构的数据库并评估围手术期数据。通过EERPE前后的问卷收集功能数据并进行统计学分析。

结果

三组患者的年龄、前列腺大小及术前前列腺特异性抗原（PSA）水平相似。平均（标准差）BMI为27（3.3）kg/m²，分别有26.8%、56.6%和16.6%的患者被归类为正常、超重和肥胖。分别有218例和123例患者进行了盆腔淋巴结清扫和保留神经手术。每组中曾接受过其他手术的患者数量无统计学差异。肥胖患者的美国麻醉医师协会评分显著更高。所有患者的平均手术时长为149分钟；三组之间的手术时长存在统计学差异，肥胖患者行EERPE或保留神经的EERPE平均需要多20分钟。无转为开放手术的情况。估计平均失血量为200毫升；4例患者接受了输血，其中无肥胖组患者。EERPE术后3个月，肥胖患者的控尿情况有变差趋势，但无统计学意义，6个月时不明显。输血率和导尿持续时间无差异。