孟繁華 徐皖江

[摘要] 目的 探討腹膜外入路腹腔鏡前列腺癌根治術(shù)治療前列腺癌的臨床療效及對免疫功能的影響。 方法 選擇杭州市富陽區(qū)第一人民醫(yī)院泌尿外科于2017年1月至2019年12月期間收治的64例早期前列腺癌患者，隨機(jī)分為兩組，每組各32例，對照組接受開放性前列腺癌根治術(shù)治療，觀察組采用腹膜外入路腹腔鏡前列腺癌根治術(shù)治療，比較兩組圍手術(shù)期臨床指標(biāo)、術(shù)后并發(fā)癥的發(fā)生情況及外周血T淋巴細(xì)胞亞群的變化，并隨訪1年的生化復(fù)發(fā)率。 結(jié)果 觀察組手術(shù)時(shí)間明顯高于對照組，術(shù)中出血量明顯少于對照組，術(shù)后導(dǎo)尿管留置、腸道功能恢復(fù)、住院時(shí)間均明顯短于對照組，術(shù)后并發(fā)癥發(fā)生率低于對照組，差異均有統(tǒng)計(jì)學(xué)意義（P<0.05）;術(shù)后1 d，兩組患者CD3+，CD4+，CD4+/CD8+水平明顯低于術(shù)前，但觀察組高于對照組（P<0.05）;術(shù)后7 d，觀察組患者CD3+，CD4+，CD4+/CD8+恢復(fù)到術(shù)前水平（P>0.05），對照組術(shù)后14 d恢復(fù)到術(shù)前水平（P>0.05）。術(shù)后1年，觀察組與對照組生化復(fù)發(fā)率比較（12.50% vs. 9.34%），差異無統(tǒng)計(jì)學(xué)意義（P>0.05）。 結(jié)論 腹膜外入路腹腔鏡前列腺癌根治術(shù)有創(chuàng)傷小、術(shù)后并發(fā)癥發(fā)生率低及術(shù)后恢復(fù)快的優(yōu)點(diǎn)，且對機(jī)體細(xì)胞免疫功能的抑制作用弱。

[關(guān)鍵詞] 腹膜外入路;腹腔鏡前列腺癌根治術(shù);前列腺癌;免疫功能;生化復(fù)發(fā)

[中圖分類號(hào)] R737.25? ? ? ? ? [文獻(xiàn)標(biāo)識(shí)碼] B? ? ? ? ? [文章編號(hào)] 1673-9701（2021）24-0066-04

Clinical efficacy of extraperitoneal laparoscopic radical prostatectomy for prostate cancer and its influence on immune function

MENG Fanhua? ?XU Wanjiang

Department of Urology，the First People′s Hospital of Fuyang District of Hangzhou City，Hangzhou? ?311400，China

[Abstract] Objective To investigate the clinical efficacy of extraperitoneal laparoscopic radical prostatectomy for prostate cancer and its influence on immune function. Methods Sixty-four patients with early prostate cancer who were admitted to the Department of Urology，the First People′s Hospital of Fuyang District of Hangzhou City from January 2017 to December 2019 were selected and randomly divided into two groups with 32 patients each. The control group received open radical prostatectomy，while the observation group received extraperitoneal laparoscopic radical prostatectomy.The perioperative clinical indicators，postoperative complications and changes in T-lymphocyte subsets in peripheral blood，and the biochemical recurrence rate during 1-year follow-up were compared between the two groups.Results The operation time of the observation group was significantly longer than that of the control group，and the amount of intraoperative blood loss was significantly less than that of the control group.The postoperative catheter indwelling time，intestinal function recovery time，and length of stay were significantly shorter than those of the control group，and the incidence of postoperative complications was lower than that in the control group，with statistically significant differences （P<0.05）. The levels of CD3+，CD4+，CD4+/CD8+ in the two groups at 1 day after the operation were significantly lower than those before the operation，but the levels of the observation group was higher than those of the control group （P<0.05）.CD3+，CD4+，CD4+/CD8+ in the observation group recovered to the preoperative level at 7 days after the operation（P>0.05），and the indicators in the control group recovered to the preoperative level at 14 days after the operation （P>0.05）.One year after the operation，there was no statistically significant difference in the biochemical recurrence rate between the observation group and the control group （12.50% vs. 9.34%） （P>0.05）. Conclusion Extraperitoneal laparoscopic radical prostatectomy shows the advantages of small trauma，low incidence of postoperative complications and quick postoperative recovery，and it has a weak inhibition on the body′s cellular immune function.