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

黄泽海; 黄晓敏; 陈泽荣; 王子明; 陈克力

doi:10.16766/j.cnki.issn.1674-4152.002487

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

doi: 10.16766/j.cnki.issn.1674-4152.002487

黄泽海¹,
黄晓敏²,
陈泽荣¹,
王子明^{1, 3},
陈克力^4, ,

1.
南方医科大学南方医院泌尿外科，广东广州 510515
2.
南方医科大学南方医院中心实验室
3.
广东省人民医院泌尿外科，广东广州 510080
4.
南方医科大学南方医院惠侨医疗中心全科医学科一病区，广东广州 510515

基金项目:

广东省科技计划项目 2020A1414040012

详细信息

通讯作者:
陈克力, E-mail: whdrchen@smu.edu.cn

中图分类号: R737.25R730.56
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- 被引次数: 0
出版历程
- 收稿日期: 2021-07-27
- 网络出版日期: 2022-09-21

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

1.
Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China

摘要

摘要: 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。
- 腹腔镜 /
- 前列腺癌根治 /
- 倾向性评分
Abstract: 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.
- Laparoscopic /
- Radical prostatectomy /
- Propensity score matching

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表 1 2组前列腺癌患者倾向性评分匹配前后临床资料比较

Table 1. Comparison of clinical data before and after propensity score matching between two groups of prostate cancer patients

项目	倾向性评分匹配前		统计量	P值	倾向性评分匹配后		统计量	P值
项目	2D腹腔镜组(82例)	3D腹腔镜组(40例)	统计量	P值	2D腹腔镜组(40例)	3D腹腔镜组(40例)	统计量	P值
年龄(x±s, 岁)	71.6±8.3	71.9±7.4	0.216^a	0.830	72.4±7.6	71.9±7.4	0.258^a	0.797
BMI(x±s)	23.8±5.0	24.5±3.7	0.099^a	0.921	23.7±5.7	24.5±3.7	0.311^a	0.757
前列腺体积[M(P₂₅, P₇₅), mL]	51.2(32.8, 72.1)	33.9(26.0, 44.0)	-3.193^b	0.001	43.6(30.4, 63.2)	33.9(26.0, 44.0)	-1.693^b	0.050
术前总PSA[M(P₂₅, P₇₅), ng/mL]	43.0(24.9, 62.2)	15.5(8.0, 43.9)	-3.586^b	< 0.001	38.4(18.1, 61.3)	15.5(8.0, 43.9)	-2.497^b	0.013
Gleason评分[M(P₂₅, P₇₅), 分]	7.0(7.0, 8.0)	7.0(6.3, 8.0)	-1.234^b	0.217	7.0(7.0, 8.0)	7.0(6.3, 8.0)	-0.234^b	0.815
单侧淋巴结清扫[例(%)]	17(20.7)	17(42.5)	6.338^c	0.012	16(40.0)	17(42.5)	0.052^c	0.820
双侧淋巴结清扫[例(%)]	23(28.0)	17(42.5)	2.548^c	0.110	16(40.0)	17(42.5)	0.052^c	0.820
肿瘤分期[例(%)]			2.196^c	0.138			0.621^c	0.431
T1~2	55(67.1)	32(80.0)			29(72.5)	32(80.0)
T3	27(32.9)	8(20.0)			11(27.5)	8(20.0)
T4	0	0			0	0
注：^a为t值，^b为Z值，^c为χ²值。

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表 2 匹配后2组前列腺癌患者围手术期有效性与安全性比较

Table 2. Comparison of perioperative efficacy and safety between two groups of prostate cancer patients after matching

组别	例数	手术时间[M(P₂₅, P₇₅), h]	住院时间[M(P₂₅, P₇₅), d]	引流管留置时间[M(P₂₅, P₇₅), d]	出血量[M(P₂₅, P₇₅), mL]	输血[例(%)]	保留神经血管束[例(%)]			尿漏[例(%)]^c	切缘阳性[例(%)]
组别	例数	手术时间[M(P₂₅, P₇₅), h]	住院时间[M(P₂₅, P₇₅), d]	引流管留置时间[M(P₂₅, P₇₅), d]	出血量[M(P₂₅, P₇₅), mL]	输血[例(%)]	无	一侧	两侧	尿漏[例(%)]^c	切缘阳性[例(%)]
2D腹腔镜组	40	3.0(2.3, 4.0)	18.0(16.0, 23.0)	5.0(4.3, 9.0)	275.0(112.5, 337.5)	5(12.5)	13(32.5)	3(7.5)	24(60.0)	11(27.5)	4(10.0)
3D腹腔镜组	40	2.3(2.0, 3.0)	18.0(16.0, 22.0)	6.0(5.0, 9.0)	50.0(50.0, 137.5)	2(5.0)	16(40.0)	1(2.5)	23(57.5)	5(12.5)	3(7.5)
统计量		-2.278^a	-0.416^a	-0.934^a	-4.426^a	1.409^b	0.487^b	1.053^b	0.052^b	2.181^b	0.175^b
P值		0.023	0.678	0.350	< 0.001	0.235	0.485	0.305	0.820	0.094	0.692
注：^a为Z值，^b为χ²值, ^c为术后第2天后出现盆腔引流液量＞100 mL，引流液肌酐检测证实为尿源性为准，尿源性提示为尿漏, 用于评估手术缝合效果。

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表 3 匹配后2组前列腺癌患者尿失禁、勃起功能、生化复发情况比较(%)

Table 3. Comparison of urinary incontinence, erectile function and biochemical recurrence between the two groups after matching(%)

组别	例数	尿控恢复率^a		勃起功能(IIEF≥17分)			生化复发率^b
组别	例数	术后3个月	术后6个月	术前	术后3个月	术后6个月	术后6个月	术后12个月
2D腹腔镜组	40	82.5(33/40)	85.0(34/40)	57.5(23/40)	55.0(11/20)	52.9(9/17)	10.0(4/40)	12.5(5/40)
3D腹腔镜组	40	75.0(30/40)	80.0(32/40)	72.5(29/40)	56.3(9/16)	66.7(10/15)	7.5(3/40)	10.0(4/40)
χ²值		0.672	1.250	1.978	0.006	0.622	0.157	0.125
P值		0.412	0.264	0.160	0.940	0.430	0.692	0.723
注：^a为以漏尿较少，每天使用少于1片尿垫为准。^b为术后复查PSA可降低至0.2 ng/mL以下，连续2次随访PSA回升至0.2 ng/mL以上并有上升趋势。术后3、6个月随访有完善勃起功能，评分人数存在减少是由于部分人员拒绝该项评估。

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