Gao Xin, Zhou Jian-Hua, Li Liao-Yuan, Qiu Jian-Guang, Pu Xiao-Yong
Department of Urology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, China.
Asian J Androl. 2009 Sep;11(5):548-56. doi: 10.1038/aja.2009.42. Epub 2009 Aug 3.
In this study we evaluate the oncological and functional results of the largest cohort of patients in China treated by laparoscopic radical prostatectomy (LRP) and with at least 3 years of follow-up. 126 inconsecutive patients (range 56-78 years, median 62.5) who had an LRP were retrospectively analyzed. The mean prostate specific antigen level and Gleason score was 13.4 ng mL(-1) and 6.4, respectively. Twenty-seven patients had unilateral or bilateral nerve preservation and 29 had pelvic lymphadenectomy. Multivariate analysis was used to adjust for differences in clinical and pathological features when comparing the risk for biochemical progression-free survival (bPFS). Urinary continence was assessed by incontinence questionnaire and erectile function by the Sexual Health Inventory for Men score. The mean operative duration was 250 min and blood loss 354 mL. Five patients received blood transfusion and nine had complications, including rectal injury (two), ureteral injury (one), active bleeding (one), bladder neck stenosis (two), paralytic ileus (one), subcutaneous hematoma (one) and port-site hernia (one). The overall positive surgical margin rate was 20.6% and correlated with pathological stage and Gleason score respectively (P = 0.03, P < 0.001 respectively). All patients had >or= 3 years of follow-up (range 3-6.75 years, mean 4.6, median 4.75). At 3 years of follow-up, the overall survival rate was 100% and the bPFS was 81.0% in all patients; 124 patients (98.4%) were continent; 22 of 27 patients (81.5%) who underwent nerve preservation retained erectile function. Our series confirms that LRP is an effective, safe and precise technique at Chinese institution.
在本研究中，我们评估了中国接受腹腔镜根治性前列腺切除术（LRP）且至少随访3年的最大患者队列的肿瘤学和功能结果。对126例接受LRP的非连续患者（年龄范围56 - 78岁，中位年龄62.5岁）进行了回顾性分析。前列腺特异性抗原水平和Gleason评分的平均值分别为13.4 ng/mL和6.4。27例患者进行了单侧或双侧神经保留，29例患者进行了盆腔淋巴结清扫术。在比较无生化进展生存（bPFS）风险时，采用多变量分析来调整临床和病理特征的差异。通过失禁问卷评估尿失禁情况，通过男性性健康量表评分评估勃起功能。平均手术时间为250分钟，失血量为354毫升。5例患者接受了输血，9例患者出现并发症，包括直肠损伤（2例）、输尿管损伤（1例）、活动性出血（1例）、膀胱颈狭窄（2例）、麻痹性肠梗阻（1例）、皮下血肿（1例）和切口疝（1例）。总体手术切缘阳性率为20.6%，分别与病理分期和Gleason评分相关（P = 0.03，P < 0.001）。所有患者的随访时间均≥3年（范围3 - 6.75年，平均4.6年，中位4.75年）。在随访3年时，所有患者的总生存率为100%，bPFS为81.0%；124例患者（98.4%）尿控良好；27例接受神经保留的患者中有22例（81.5%）保留了勃起功能。我们的系列研究证实，LRP在中国机构是一种有效、安全且精确的技术。
