一项基于单中心腹腔镜前列腺癌手术难度的多重影响因素分析

目的寻找有效的围术期相关术前数据预测前列腺癌患者行腹腔镜根治性前列腺切除术的手术难度和风险。方法回顾性分析2013年8月至2017年4月接受腹腔镜前列腺根治性切除术的125例前列腺癌患者的围术期资料,分为3组:A组为早期进行的48例腹膜外前列腺癌根治术患者、B组为后期进行的48例腹膜外前列腺癌根治术患者、C组为29例经腹腔前列腺癌根治术患者。将3组中符合体质指数≥25、前列腺体积≥30 mL、术前PSA水平≥10 ng/mL、有中叶突出这4个条件中的3~4个的患者划为高危组,0~2个的患者划为低危组。分别在A、B、C 3组患者中比较高危组与低危组之间在手术切缘阳性率、手术时长及术中出血量等可以直观体现手术难度数据上的差异。结果A、B、C 3组中,高危组的手术切缘阳性率、手术时长及术中出血量均显著高于低危组,差异具有统计学意义(P<0.05)。结论体质指数、前列腺体积、术前PSA水平、中叶突出4个因素与手术难度密切相关,术前准确识别影响因素的数目和程度,有助于外科医师预断手术难度。

A asingle-center experience of the factors affecting the difficulty of laparoscopic radical prostatectomy

Objective To predict the surgical difficulty and risk of patients with prostate cancer treated with laparoscopic radical prostatectomy(LRP).Methods The perioperative data of 125 prostate cancer patients receiving LRP during Aug.2013 and Apr.2017 were retrospectively analyzed.The patients were divided into 3 groups:group A(n=48,received retroperitoneal route LRP earlier),group B(n=48,received retroperitoneal route LRP later),and group C(n=29,received peritoneal route LRP).In view of the surgeons experience,the patients were classified further according to the body mass index(BMI)≥25,prostate volume≥30 mL,preoperative prostate specific antigen(PSA)≥10 ng/mL,and presence of middle lobe instruction.In groups A,B and C,those with 3-4 risk factors were classified into high-risk group,and those with 0-2 risk factors were classified into low-risk group.The positive rate of surgical margin(PSM),operation time and estimated blood loss were compared between the high-risk and low-risk groups in groups A,B and C.Results The PSM,operation time and estimated blood loss were higher or longer in the high-risk groups than in the low-risk groups(P<0.05).Conclusion Four factors including BMI,prostate volume,preoperative PSA and the presence of middle lobe instruction were highly correlated with the difficulty of laparoscopic radical prostatectomy.Accurately distinguishing the number and level of risk factors can assist doctors in assessing the surgical difficulty.