目的 探讨腹腔镜下前列腺癌根治术后切缘阳性的相关因素. 方法 2004年2月至2007年9月,采用腹膜外途径行腹腔镜下前列腺癌根治术33例.患者年龄57～78岁,平均70岁.术前均经病理证实前列腺癌诊断.Gleason评分3+3者14例(43%)、3+4者11例(33%)、4+3者6例(18%)、4+4者2例(6%),临床分期T1a～T1b 4例(12%)、T1c14例(43%)、T2a～T2b 5例(15%)、T2c 10例(30%).多因素回归分析比较根治术后标本切缘阳性与阴性组临床及生物学参数指标. 结果 腹腔镜下完成前列腺癌根治术31例,中转开放手术2例.术后病理报告切缘阳性9例(27%)、阴性24例(73%).切缘阳性组与阴性组患者术前临床分期T2c分别为6例(67%)和4例(17%)(P=0.010),术后Gleason评分＞7分者分别为3例(33%)和0例(P=0.015),术前PSA＞20ng/ml分别为4例(44%)和5例(21%)(P=0.178),直肠指诊可触及结节或局部质硬者分别为4例(44%)和9例(38%)(P=0.509).多因素回归分析结果显示:临床分期T2c与切缘阳性呈独立正相关关系(OR=24.69),T2c患者术后切缘阳性率明显增高.术前Gleason评分＞7分者切缘阳性率增高,PSA＞20 ng/ml者切缘阳性率有增高趋势,但二者需结合临床分期等指标综合判断对术后切缘阳性的影响.直肠指诊触及结节或质硬者切缘阳性率略增高,可作为参考指标. 结论 影响腹腔镜下前列腺癌根治术后切缘阳性的因素为临床分期、术前病理Gleason评分、总PSA和直肠指诊.临床分期可以作为预测术后切缘阳性的独立相关因素,≥T2c期的患者术后切缘阳性率明显增加.Gleason评分＞7分、PSA＞20 ng/ml作为重要参考指标,应结合临床分期综合分析;直肠指诊有结节或质硬可作为参考指标.
Objective To determine relative risk factors for positive surgical margins in extraperitoneal laparoscopic radical prostatectomy(LRP). Methods From February 2004 to September 2007,33 patients(mean age 70 years old)with prostate cancers underwent extraperitoneal LRP.All patients were diagnosed by pathology preoperatively.Gleason score:3+3 14 cases(43%),3+4 11 cases(33%),4+3 6 cases(18%),4+4 2 cases(6%).Clinical stage:T1a-T1b 4 cases(12%),T1c 14 cases(43%),T2a-T2b 5 cases(15%),T2c10 cases(30%).Logistic regression analyses were performed. Results LRP was successfully performed on 31 cases.There were 2 cases converted to open surgery.Nine cases(27%)had PSMs.There were 6 cases(67%)and 4 cases(17%)of clinical stage T2c in PSM and negative surgical margin(NSM)groups respectively(P=0.010).There were 3 cases(33%)and 0(0)with high Gleason score(higher than 7)in PSM and NSM cases(P=0.015).There were 4 cases(44%)and 5 cases(21%)with t-PSA higher than 20dg/ml in PSM and NSM cases respectively(P=0.178).In these 9 cases,there were 4 cases(44%)positive with DRE.However there were 9 in the 24 NSM cases(38%)(P=0.509).Clinical stage T2c was independently positively correlated with PSM(OR=24.69).High Gleason score(higher than 7)and t-PSA higher than 20 ng/ml were positively correlated with PSM. Conclusions Clinical stage is positively correlated with PSM.It is an independent factor.High Gleason score(higher than 7)and t-PSA higher than 20 ng/ml mignt be the risk factors in predicting PSM and should be used together with clinical stage.Positive DRE findings may be also useful to predict PSM.