Weldon V E, Tavel F R, Neuwirth H, Cohen R
Department of Urology, University of California School of Medicine, San Francisco, USA.
J Urol. 1995 May;153(5):1565-9.
Positive specimen margins and detectable postoperative prostate specific antigen (PSA) levels were analyzed after 200 consecutive radical perineal prostatectomies for clinical stages T1 and T2 adenocarcinoma of the prostate. Clinical parameters that correlated with lymph node metastases in concomitant pelvic lymphadenectomies were also noted. At a mean followup of 35 months 79% of the patients had undetectable PSA levels. Step-section pathological analysis of specimens obtained by either nerve sparing or extended radical modifications revealed that 41% of the tumors were organ confined and 56% had negative margins. Selective sacrifice of the posterolateral periprostatic fascia and the enclosed neurovascular bundle achieved negative margins and undetectable PSA levels despite capsular penetration in 15% of all patients. Of all positive margins with the perineal approach, solitary positive apical and posterolateral margins were infrequent (7% and 16%, respectively) but solitary positive anterior margins were more so (25%). Of those positive anterior margins 41% appeared to be artifactual and 45% might have been eliminated by avoiding avulsion of the puboprostatic ligaments. Pelvic lymphadenectomy could have been eliminated in 58% of the patients (clinical stage T2b or less, biopsy Gleason score 6 or less and PSA level 11 or less, for a node negative predictive value of 99%).
对200例连续接受经会阴根治性前列腺切除术的临床T1和T2期前列腺腺癌患者，分析术后标本切缘阳性情况及可检测到的前列腺特异性抗原（PSA）水平。同时记录在同期盆腔淋巴结清扫术中与淋巴结转移相关的临床参数。平均随访35个月时，79%的患者PSA水平检测不到。对采用保留神经或扩大根治术式获取的标本进行连续切片病理分析显示，41%的肿瘤局限于器官内，56%的标本切缘阴性。选择性切除前列腺后外侧筋膜及其包裹的神经血管束，尽管15%的患者出现包膜侵犯，但仍实现了切缘阴性和PSA水平检测不到。在经会阴手术切缘阳性的患者中，孤立性尖部和后外侧切缘阳性较少见（分别为7%和16%），但孤立性前切缘阳性较多见（25%）。在那些前切缘阳性患者中，41%似乎是人为造成的，45%可能通过避免耻骨前列腺韧带撕脱而消除。58%的患者（临床分期T2b或更低、活检Gleason评分6或更低且PSA水平11或更低）可避免盆腔淋巴结清扫，其淋巴结阴性预测值为99%。
