【摘要】：[目的]前列腺癌(Prostate Cancer, PCa)是泌尿外科的常見惡性腫瘤之一,既往多運(yùn)用傳統(tǒng)二維(2-Dimentional,2D)腹腔鏡技術(shù)進(jìn)行PCa的根治性手術(shù)治療。近年來隨著三維(3-Dimentional,3D)成像技術(shù)在腹腔鏡手術(shù)中的應(yīng)用、發(fā)展及其所具有的優(yōu)勢,越來越多的前列腺根治性切除手術(shù)(Radical Prostatectomy, RP)采用3D腹腔鏡技術(shù)輔助。本研究通過與傳統(tǒng)2D腹腔鏡RP的臨床資料進(jìn)行對比,評價(jià)3D腹腔鏡RP的臨床價(jià)值及安全性。[方法]回顧性分析山東大學(xué)齊魯醫(yī)院泌尿外科2015年1月至2016年1月期間因PCa行腹腔鏡RP的45例患者的相關(guān)臨床資料,其中包括3D腹腔鏡手術(shù)組20例和傳統(tǒng)2D腹腔鏡手術(shù)組25例。所有患者術(shù)前均被經(jīng)超聲前列腺穿刺活檢的病理結(jié)果證實(shí)為PCa。通過整理相關(guān)臨床資料,我們對比研究了患者的一般人口學(xué)信息、術(shù)前血清前列腺特異性抗原(Prostate Specific Antigen, PSA)、手術(shù)時(shí)間、術(shù)中出血量、術(shù)后引流時(shí)間、胃腸蠕動恢復(fù)時(shí)間、術(shù)后住院天數(shù)、術(shù)后并發(fā)癥情況、術(shù)后病理結(jié)果、住院總費(fèi)用、術(shù)后相關(guān)治療、術(shù)后隨訪3個(gè)月控尿情況及PSA生化變化,并通過問卷評分的方式評估了手術(shù)者的工作負(fù)荷、技術(shù)操作難度、畫面清晰度及視覺舒適度以及護(hù)理人員手術(shù)配合的工作負(fù)荷等各項(xiàng)指標(biāo)。采用SPSS 19.0軟件進(jìn)行統(tǒng)計(jì)學(xué)分析,計(jì)量資料的比較用獨(dú)立樣本t檢驗(yàn),計(jì)數(shù)資料的比較根據(jù)數(shù)據(jù)特點(diǎn)采用x2檢驗(yàn)或Fisher精確概率計(jì)算,以P0.05為差異有統(tǒng)計(jì)學(xué)意義。[結(jié)果]兩組患者的年齡、體重等一般人口學(xué)信息的差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。所有45例手術(shù)均在全身麻醉下順利實(shí)施,術(shù)中未改變手術(shù)方式。3D組患者平均手術(shù)時(shí)間為218.25±20.47min,2D組平均手術(shù)時(shí)間為254.20±40.25min,兩者有顯著統(tǒng)計(jì)學(xué)差異(P=0.080)。兩組患者術(shù)中術(shù)后均未輸血,3D組平均預(yù)估術(shù)中出血量為130.00±57.12mL,2D組平均術(shù)中出血量為194.00±119.30mL,3D組的平均術(shù)中出血量明顯少于2D組,差異有統(tǒng)計(jì)學(xué)意義(P=0.041)。3D組術(shù)后引流時(shí)間為7.20±2.14天,短于2D組的術(shù)后引流時(shí)間9.92±3.11天,差異具顯著統(tǒng)計(jì)學(xué)意義(P=0.028)。兩組患者術(shù)中均未出現(xiàn)明顯并發(fā)癥,術(shù)后有部分患者出現(xiàn)吻合口漏及淋巴漏,其中3D組未出現(xiàn)無吻合口漏(0%)、1例淋巴漏(5%),2D組出現(xiàn)1例吻合口漏(4%)、4例淋巴漏(16%),差異不具統(tǒng)計(jì)學(xué)意義(P0.05)。對比兩組的術(shù)后病理結(jié)果,切緣陽性率(15%vs.20%)與Gleason評分(7.12±1.18 vs.7.44±0.92)無顯著統(tǒng)計(jì)學(xué)差異(P0.05)。對患者的隨訪研究顯示,3D組患者術(shù)后3個(gè)月的滿意控尿率顯著高于2D組(85%vs.56%1 P=0.037)。在住院總費(fèi)用上,3D組患者平均住院總費(fèi)用為57217.91±7593.28元,2D組患者平均住院總費(fèi)用為58829.73±11089.31元,無顯著統(tǒng)計(jì)學(xué)差異(P=0.701)。對手術(shù)者而言,3D腹腔鏡的工作負(fù)荷相比于2D腹腔鏡更輕(3.55±0.52 vs.4.09±0.54),操作難度更低(3.36±0.50 vs.4.18±0.40),畫面清晰度更高(4.64±0.50 vs.3.73±0.47),而視覺舒適度的差別不明顯(3.91±0.70 vs.3.55±0.52)；護(hù)理人員認(rèn)為3D腹腔鏡的工作負(fù)荷與2D腹腔鏡無顯著差異(3.00±1.20 vs.3.13±0.83)。[結(jié)論]3D腹腔鏡技術(shù)與傳統(tǒng)2D腹腔鏡技術(shù)相比,在RP中具有手術(shù)時(shí)間短、術(shù)中出血量少、術(shù)后引流時(shí)間及住院時(shí)間短、術(shù)后3個(gè)月控尿率高、手術(shù)者工作負(fù)荷低、手術(shù)操作難度低、圖像清晰度高等優(yōu)點(diǎn),并具相當(dāng)?shù)陌踩?適合在各級臨床機(jī)構(gòu)中廣泛推廣。
[Abstract]:[Objective] Prostate Cancer (PCa) is one of the common malignant tumors in the Department of urology. The traditional two dimensional (2-Dimentional, 2D) laparoscopy has been used to treat the radical operation of PCa. In recent years, with the application of the three-dimensional (3-Dimentional, 3D) imaging technology in the laparoscopic operation, the development and the advantages of the laparoscopic operation are increasing. The more radical resection of the prostate (Radical Prostatectomy, RP) was assisted by 3D laparoscopy. The clinical value and safety of the 3D laparoscopic RP were evaluated by comparison with the clinical data of the traditional 2D laparoscopic RP. [Methods] a retrospective analysis of the Department of Urology, Qilu Hospital, Shandong University from January 2015 to January 2016, was reviewed. The clinical data of 45 patients with PCa underwent laparoscopic RP, including 20 cases in the 3D laparoscopy group and 25 cases in the traditional 2D laparoscopy group. All the patients were confirmed by the pathological results of the ultrasound prostate biopsy before the operation. The general demographic information of the patients was compared to the general demographic information of the patients. Serum prostate specific antigen (Prostate Specific Antigen, PSA), operation time, intraoperative bleeding, postoperative drainage time, recovery time of gastrointestinal peristalsis, postoperative hospital days, postoperative complications, postoperative pathological results, total hospitalization expenses, postoperative related treatment, postoperative follow-up 3 months of urine control and biochemical changes of PSA, and through a questionnaire review The working load of the operator, the difficulty of technical operation, the clarity of the picture and the visual comfort and the working load of the nursing staff were evaluated by the method of SPSS 19. The statistical analysis was carried out by the software of the 19 software, the comparison of the data was compared with the independent sample t test, and the comparison of the count data was tested by the x2 test according to the characteristics of the data. Or Fisher accurate probability calculation, with P0.05 difference statistically significant. [results] the age, weight and other general demographic information of the two groups were not statistically significant (P0.05). All 45 cases were successfully implemented under general anesthesia, and the average operation time of the.3D group was 218.25 + 20.47min, and 2D group was flat. The average operation time was 254.20 + 40.25min, and there was significant difference between the two groups (P=0.080). The two groups had no blood transfusion during the operation, the average estimated bleeding amount in group 3D was 130 + 57.12mL, and the mean intraoperative bleeding amount in 2D group was 194 + 119.30mL. The mean intraoperative bleeding volume in group 3D was less than that of the 2D group, and the difference was statistically significant (P=0.041).3D group operation. The postoperative drainage time was 7.20 + 2.14 days, and the postoperative drainage time was 9.92 + 3.11 days shorter than the 2D group. The difference had significant statistical significance (P=0.028). There were no obvious complications in the two groups. Some of the patients had anastomotic leakage and lymphatic leakage, of which there was no anastomotic leakage (0%) in group 3D, 1 cases of lymphatic leakage (5%), and 1 cases in group 2D. Leakage (4%), 4 cases of lymphatic leakage (16%), the difference was not statistically significant (P0.05). Compared with the postoperative pathological results of the two groups, the positive rate of cutting edge (15%vs.20%) and Gleason score (7.12 + 1.18 vs.7.44 + 0.92) were not significantly different (P0.05). The follow-up study showed that the satisfactory rate of urinary control in group 3D patients was significantly higher than that of the 2D group (85%vs.56%1 P) at 3 months after operation (85%vs.56%1 P) =0.037). The average total hospitalization cost of patients in group 3D was 57217.91 + 7593.28 yuan, and the average total hospitalization cost in group 2D was 58829.73 + 11089.31 yuan, without significant statistical difference (P=0.701). For the operators, the operating load of 3D laparoscope was lighter (3.55 + 0.52 vs.4.09 + 0.54) than that of 2D (3.55 + 0.52 vs.4.09 + 0.54), and the difficulty of operation was lower (3.36 0.50 vs.4.18 + 0.40), the picture clarity was higher (4.64 + 0.50 vs.3.73 + 0.47), while the difference of visual comfort was not obvious (3.91 + 0.70 vs.3.55 + 0.52), and there was no significant difference between the working load of 3D laparoscopy and 2D laparoscopy (3 + 1.20 vs.3.13 + 0.83). [conclusion]3D laparoscopy was compared with traditional 2D laparoscopy, in RP It has short operation time, less bleeding in the operation, short time of postoperative drainage and hospitalization, high rate of urine control in 3 months after operation, low workload of the operation, low difficulty of operation, high definition of image, and considerable safety. It is suitable for extensive popularization in clinical institutions at all levels.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R737.25

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10 任樂豪;腹腔鏡輔助與開腹進(jìn)展期胃癌根治術(shù)的臨床對比研究[D];山東大學(xué);2016年

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