Haab F, Boccon-Gibod L, Delmas V, Boccon-Gibod L, Toublanc M
Department of Urology, CHU Bichat, Paris, France.
Br J Urol. 1994 Nov;74(5):626-9. doi: 10.1111/j.1464-410x.1994.tb09195.x.
To compare retrospectively the efficacy of radical perineal and retropubic prostatectomy in patients with T1, T2 cancer of the prostate.
From January 1991 to January 1993, 71 patients with T1, T2 carcinoma of the prostate aged 52-74 years underwent radical retropubic prostatectomy (36) or radical perineal prostatectomy (35); this was preceded by endosurgical lymphadenectomy. The two groups were identical with regard to age (64 vs 66 years), clinical stage (T1a 17% vs 25%, T2 82% vs 74%), mean and median pre-operative prostate-specific antigen (PSA) (20 vs 26, 11 vs 15 using the YANG polyclonal assay n < 2.5 ng/ml). Radical retropubic prostatectomy and radical perineal prostatectomy were performed using standard procedures. Specimens were inked and analysed; operative time, volume of blood transfusions, duration of hospital stay, peri-operative complications, sexual function, urinary continence and quality of the specimens were assessed retrospectively.
Both groups were identical as far as operation time, hospital stay, complications (one rectal injury in each group), specimen weight and pathology were concerned. The proportions of organ-confined (54% in radical perineal prostatectomy group vs 55% in radical retropubic prostatectomy group) and margin-positive cancers (37% in radical perineal prostatectomy group vs 39% in radical retropubic prostatectomy group) were identical. The volume of blood transfusion was significantly less in the radical perineal prostatectomy group: 54% required transfusion compared with 100% in the radical retropubic prostatectomy group), 7% of radical perineal prostatectomy patients received homologous transfusion vs 38% of the radical retropubic prostatectomy patients; 11 and 3% of the patients were potent 3-6 months after surgery. Two anastomotic strictures developed after radical retropubic prostatectomy and none after the radical perineal prostatectomy. Continence was achieved at 3 months in 71% of the radical perineal prostatectomy group and in 82% of the radical retropubic prostatectomy group; by 6 months 88% of the patients were dry in both groups.
When nodal status has been assessed by lymph node dissection (open or endosurgical), radical perineal prostatectomy is a reasonable, minimally invasive alternative to radical retropubic prostatectomy provided that impotence and a slower return to full continence are accepted.
回顾性比较根治性会阴前列腺切除术与耻骨后前列腺切除术治疗T1、T2期前列腺癌患者的疗效。
1991年1月至1993年1月，71例年龄在52 - 74岁的T1、T2期前列腺癌患者接受了根治性耻骨后前列腺切除术（36例）或根治性会阴前列腺切除术（35例）；术前均先行内镜下淋巴结清扫术。两组患者在年龄（64岁对66岁）、临床分期（T1a期分别为17%对25%，T2期分别为82%对74%）、术前前列腺特异性抗原（PSA）均值及中位数（采用YANG多克隆检测法，均值分别为20对26，中位数分别为11对15，n < 2.5 ng/ml）方面均无差异。根治性耻骨后前列腺切除术和根治性会阴前列腺切除术均采用标准术式。标本标记后进行分析；回顾性评估手术时间、输血量、住院时间、围手术期并发症、性功能、尿失禁情况及标本质量。
两组在手术时间、住院时间、并发症（每组各有1例直肠损伤）、标本重量及病理方面均无差异。局限于器官内的癌症比例（根治性会阴前列腺切除术组为54%，根治性耻骨后前列腺切除术组为55%）及切缘阳性癌症比例（根治性会阴前列腺切除术组为37%，根治性耻骨后前列腺切除术组为39%）相同。根治性会阴前列腺切除术组的输血量显著较少：54%的患者需要输血，而根治性耻骨后前列腺切除术组为100%；根治性会阴前列腺切除术组7%的患者接受了同源输血 vs 根治性耻骨后前列腺切除术组38%的患者；术后3 - 6个月，两组患者分别有11%和3%仍有性功能。根治性耻骨后前列腺切除术后出现2例吻合口狭窄，根治性会阴前列腺切除术后无吻合口狭窄发生。根治性会阴前列腺切除术组71%的患者在术后3个月实现控尿，根治性耻骨后前列腺切除术组为82%；至术后6个月，两组88%的患者均能保持干爽。
当通过淋巴结清扫术（开放或内镜下）评估淋巴结状态时，若接受阳痿及完全控尿恢复较慢的情况，根治性会阴前列腺切除术是根治性耻骨后前列腺切除术合理的、微创的替代术式。
