本文選題：前列腺腫瘤 + 腹腔鏡前列腺癌根治術(shù)��； 參考：《實用醫(yī)學(xué)雜志》2016年13期

【摘要】：目的:探討改良單孔多通道腹腔鏡前列腺癌根治術(shù)經(jīng)腹腔或腹膜外入路治療前列腺癌的臨床療效,及其對患者免疫功能的影響。方法:回顧性分析2012年1月至2015年12月采用改良單孔多通道腹腔鏡手術(shù)治療前列腺癌59例,其中經(jīng)腹膜外入路(A組,39例),經(jīng)腹腔入路(B組,20例)。經(jīng)術(shù)前B超、CT或MRI和穿刺病理診斷為前列腺癌,臨床分期均為T1-T2c,N0M0。評估兩種術(shù)式的手術(shù)時間、術(shù)中出血量、腸功能恢復(fù)時間及術(shù)后住院時間,并檢測患者手術(shù)前后血液的免疫指標(biāo):前列腺特異性抗原(TPSA、FPSA)、免疫球蛋白(IgG、IgA、IgM、C3、C4)及T淋巴細胞亞群(CD3~+、CD4~+、CD8~+、CD4~+/CD8~+)。結(jié)果:所有手術(shù)均順利完成,無中轉(zhuǎn)開放手術(shù)。A組手術(shù)時間、術(shù)中出血量、腸功能恢復(fù)時間、術(shù)后住院時間依次為(133.8±68.6)min、(75.6±51.3)mL、(2.2±0.7)d、(14.7±3.6)d,B組分別為(159.4±78.1)min、(102.2±70.8)mL、(2.9±1.1)d、(15.2±4.1)d;A組在減少出血量,縮短手術(shù)時間及腸功能恢復(fù)時間明顯優(yōu)于B組(P0.05)。A組術(shù)后IgG、IgA、C3、C4、CD3~+、CD4~+、CD4~+/CD8~+明顯高于B組(P0.05);兩組術(shù)后TPSA、FPSA、lg M水平,差異無統(tǒng)計學(xué)意義(P0.05)。隨訪3~36個月,平均15個月,3例失訪,隨訪患者無遠期并發(fā)癥,影像學(xué)檢查未見腫瘤復(fù)發(fā)或轉(zhuǎn)移。結(jié)論:與經(jīng)腹腔入路相比,腹膜外入路改良單孔多通道腹腔鏡前列腺癌根治術(shù)具有視野清晰,對腹腔器官影響小,手術(shù)時間短,術(shù)中出血少,術(shù)后恢復(fù)快等優(yōu)點,更具有保護免疫功能的優(yōu)勢。
[Abstract]:Objective: to investigate the clinical effect of modified single hole multichannel laparoscopic radical prostatectomy for prostate cancer through peritoneal or extraperitoneal approach and its effect on the immune function of patients. Methods: from January 2012 to December 2015, 59 cases of prostate cancer were treated by modified single-hole multi-channel laparoscopic surgery, including 39 cases of group A with extraperitoneal approach and 20 cases of group B with intraperitoneal approach. It was diagnosed as prostate cancer by CT or MRI and puncture pathology before operation, and the clinical stage was T _ 1-T _ 2C ~ (2) C ~ (2) N _ (0) M _ (0). The time of operation, the amount of blood lost during operation, the time of recovery of intestinal function and the time of hospitalization after operation were evaluated. The immunological parameters of the patients before and after operation were determined as follows: TPSAA FPSAA, IgGG, IgMN, C4) and T lymphocyte subsets CD8 ~ + CD8 ~ + / CD8 ~ +. Results: all the operations were completed successfully. The operative time, the amount of blood loss, the recovery time of intestinal function, and the postoperative hospitalization time were 133.8 鹵68.6 min and 75.6 鹵51.3 mL / min respectively in group B, which were 159.4 鹵78.1 min, 102.2 鹵70.8mL, 15.2 鹵4.1 d, respectively. The shortening of operation time and the recovery time of intestinal function in group A were significantly better than those in group B (P 0.05). Group A was significantly higher than group B (P 0.05) in the level of IGG C _ (3) C _ (3) C _ (4) and C _ (4) T _ (4) and C _ (4) ~ / C _ (8), and there was no significant difference between the two groups in the level of TPSAN FPSAL M after operation. The patients were followed up for 3 ~ 36 months, with an average of 15 months. There were no long-term complications and no recurrence or metastasis were found in the imaging examination. Conclusion: compared with the transperitoneal approach, the modified single-hole multi-channel laparoscopic radical prostatectomy via extraperitoneal approach has the advantages of clear vision, less influence on abdominal organs, shorter operative time, less intraoperative bleeding, and faster recovery after operation. It has the advantage of protecting immune function.
【作者單位】： 廣東省第二人民醫(yī)院泌尿外科;南方醫(yī)科大學(xué) 廣東省第二人民醫(yī)院泌尿外科;
【基金】：廣東省醫(yī)學(xué)科研基金(編號:B2014064)
【分類號】：R737.25

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