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目的探讨新辅助内分泌治疗对腹腔镜前列腺癌根治术手术参数的影响,评价术前实施新辅助内分泌治疗的安全性和有效性。方法回顾性分析126例局限性前列腺癌患者的临床资料,根据治疗方式不同分为腹腔镜前列腺根治术(LRP)组和新辅助内分泌治疗(NHT)组,其中LRP组95例,NHT组31例。对比分析手术时间、出血量、切缘阳性率、住院时间、2年生化复发率和并发症等指标。结果 126例患者均顺利完成手术。LRP组和NHT组患者的平均手术时间分别为(115±25)min和(120±20)min(P>0.05),术中平均出血量分别为(110±35)ml和(116±28)ml(P>0.05),切缘阳性率分别为42.1%和19.4%(P<0.05),平均住院时间分别为(11.3±2.1)d和(13.5±3.6)d(P>0.05)。术后随访6～54个月,LRP组和NHT组的2年生化复发率分别为27.4%(17/62)和33.3%(7/21),差异无统计学意义(P>0.05)。LRP组2例(2.1%)发生直肠损伤,5例(5.3%)不同程度的尿失禁,3例(3.2%)吻合口尿漏;NHT组直肠损伤为1例(3.2%),不同程度尿失禁2例(6.5%),吻合口尿漏1例(3.2%)。此外,NHT组还发生了尿道狭窄1例(3.2%)。结论新辅助内分泌治疗不会增加局限性前列腺癌患者的手术风险;新辅助内分泌治疗能降低手术患者的切缘阳性率,但是不能降低其2年生化复发率,有效性有待进一步考察。
Objective To investigate the effect of neoadjuvant endocrine therapy on the surgical parameters of laparoscopic radical prostatectomy and evaluate the safety and efficacy of neoadjuvant endocrine therapy before operation. Methods The clinical data of 126 patients with localized prostate cancer were retrospectively analyzed. According to the different treatment methods, they were divided into laparoscopic radical prostatectomy (LRP) and neoadjuvant endocrine therapy (NHT) group, 95 cases in LRP group and 31 cases in NHT group . Comparative analysis of operation time, bleeding volume, positive margins, hospitalization time, 2-year biochemical recurrence rate and complications and other indicators. Results 126 patients completed the operation successfully. Mean operative time was (115 ± 25) min and (120 ± 20) min in LRP group and NHT group (P> 0.05). The mean intraoperative blood loss was (110 ± 35) ml and (116 ± 28) ml (P> 0.05). The positive rate of the margins was 42.1% and 19.4% respectively (P <0.05). The average length of hospital stay was (11.3 ± 2.1) d and (13.5 ± 3.6) d, respectively. The biochemical recurrence rates in LRP group and NHT group were 27.4% (17/62) and 33.3% (7/21) respectively, with no significant difference between the two groups (P> 0.05). Rectal injury occurred in 2 cases (2.1%) in LRP group, urinary incontinence in 5 cases (5.3%) and urinary leakage in 3 cases (3.2%). Rectal injury in NHT group was 1 case Incontinence in 2 cases (6.5%), anastomotic leakage in 1 case (3.2%). In addition, NHT group also occurred in 1 case of urethral stricture (3.2%). Conclusion Neoadjuvant endocrine therapy does not increase the surgical risk in patients with localized prostate cancer. Neoadjuvant endocrine therapy can reduce the positive rate of surgical margins in surgical patients, but can not reduce its 2-year biochemical recurrence rate. The effectiveness needs further investigation.