3D腹腔镜与2D腹腔镜下腹膜外前列腺癌根治术双中心回顾性队列研究

  目的  分析比较2D腹腔镜下与3D腹腔镜下前列腺癌根治术治疗前列腺癌的有效性与安全性。  方法  回顾性分析南方医科大学南方医院泌尿外科及广东省人民医院2个中心泌尿外科2015年1月1日—2018年1月1日期间行腹腔镜前列腺癌根治术患者，共122例患者临床资料，根据所采用的腔镜方式不同，分为3D腹腔镜组(40例)和2D腹腔镜组(82例)；通过倾向性评分匹配法对2D腹腔镜前列腺癌根治组(2D腹腔镜组)和3D腹腔镜前列腺癌根治组(3D腹腔镜组)患者根据年龄、BMI、前列腺体积、术前总前列腺特异性抗原(PSA)、前列腺穿刺病理Gleason评分等进行匹配后2组各纳入40例。对匹配成功的患者采用尿失禁生活质量量表(I-QOL)、勃起功能国际问卷-5(IIEF-5)进一步随访，分析2种手术方式效果差异，对比分析2种手术方式安全性。  结果  3D腹腔镜组比2D腹腔镜组手术时间短2.3(2.0, 3.0)h vs. 3.0(2.3, 4.0)h, P=0.023]，出血量更少50.0(50.0, 137.5)mL vs. 275.0(112.5, 337.5) mL, P＜0.001]；但2组切缘阳性率、尿漏率、尿控恢复率、性功能恢复及无生化复发率比较差异无统计学意义(均P＞0.05)。  结论  3D腹腔镜下前列腺癌根治术可获得更好视野，减少手术时间、出血量。但2组远期随访切缘阳性率、尿控恢复率、性功能恢复及生化复发率等方面手术效果相近。 

Three-dimensional versus two-dimensional imaging systems in extraperitoneal radical prostatectomy for prostate cancer: A bicenter and retrospective cohort study

  Objective  To compare the efficacy and safety of three-dimensional (3D) and two-dimensional (2D) imaging systems in laparoscopic extraperitoneal radical prostatectomy (LERP) for prostate cancer.  Methods  The clinical data of 122 consecutive patients diagnosed with prostate cancer was analyzed. Those patients were underwent LERP with 2D or 3D imaging systems in Nanfang Hospital and Guangdong General Hospital between January 1st, 2015 to 1 January 1st, 2018. Patients were divided into 3D (n=40) and 2D (n=82) groups according to different endoscopic methods. The patients in 2D group and 3D group were matched by propensity score matching method according to age, BMI, prostate volume, preoperative total prostate specific antigen (PSA) and Gleason score of prostate puncture pathology. After matching, 40 cases were included in each group. The matched patients were further followed up with urinary incontinence quality of life scale (I-QOL) and international index of erectile function-5 (IIEF-5). The effects of the two surgical methods were analyzed, and the safety was compared and analyzed.  Results  The operation time of 3D group was shorter than that of 2D group 2.3 (2.0, 3.0) h vs. 3.0 (2.3, 4.0) h, P=0.023], and the blood loss of 3D group was less 50.0 (50.0, 137.5) mL vs. 275.0 (112.5, 337.5) mL, P < 0.001]. There were no statistically significant differences in positive surgical margin rates, urinary leakage rate, recovery rate of urinary control, recovery of sexual function and biochemical recurrence rate between the two groups (all P>0.05).  Conclusion  3D LERP has a better surgical field, shorter operation time, and less blood loss compared to 2D LERP. However, the long-term follow-up results of the two groups were similar in the positive surgical margin rates, the recovery rate of urinary control, the recovery of sexual function and biochemical recurrence rate.