Clinical study on the effect of different pathways of prostate puncture biopsy on the procedure of radical prostate cancer surgery
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摘要: 目的 探讨不同径路前列腺穿刺活检对于腹腔镜前列腺癌根治手术过程及预后的影响。方法 对2018年8月—2021年6月收治的符合入组标准的42例前列腺癌患者，按穿刺径路不同分为经会阴组22例和经直肠组20例，比较两组患者手术时间、手术成功率、分离前列腺尖部时间、出血量、分离直肠前间隙时间、术后病理分期及切缘情况、术后直肠相关并发症、术后2个月尿失禁发生率。结果 经会阴组22例患者均顺利完成腹腔镜前列腺根治术，手术时间(115.55±10.90) min，分离直肠前间隙时间(17.64±2.13) min，分离前列腺尖部时间(6.36±1.00) min，出血量(193.64±20.37) mL，术后无直肠相关并发症；经直肠组20例患者均顺利完成腹腔镜前列腺根治术，手术时间(140.65±10.63) min，分离直肠前间隙时间(35.65±3.73) min，分离前列腺尖部时间(6.60±1.54) min，出血量(258.60±33.33) mL，术后无直肠相关并发症。两组术后病理分期及切缘情况、术后2个月尿失禁发生率比较差异无统计学意义，经会阴组在手术时间、分离直肠前间隙时间、出血量均优于经直肠组，差异有统计学意义(P＜0.05)。结论 2种穿刺活检术对于前列腺癌根治术的成功率及直肠损伤率无明显差异，但经会阴前列腺穿刺活检术对直肠前间隙干扰较小，能够缩短分离直肠前间隙时间和手术总时间，减少手术出血量，降低手术难度。Abstract: Objective To investigate the effect of different pathways of prostate puncture biopsy on the procedure and prognosis of laparoscopic radical prostate cancer surgery.Methods Using a retrospective study, 42 patients with prostate cancer who met the inclusion criteria and were admitted from August 2018 to June 2021 were divided into 22 cases in the transperineal group and 20 cases in the transrectal group according to the puncture pathways. The operative time, success rate, time to separate the apical part of the prostate, bleeding volume, time to separate the anterior rectal space and postoperative rectal related complications between the two groups of patients were compared.Results All 22 patients in the transperineal group were successfully completed laparoscopic radical prostatectomy with an operative time of (115.55±10.90) min. The separation time of the anterior rectal space was (17.64±2.13) min, and the separation of apical part of the prostate was (6.36±1.00) min. The bleeding volume was (193.64±20.37) mL, and there were no postoperative rectal complications. All 20 patients in the transrectal group were successfully completed laparoscopic radical prostatectomy with an operative time of (140.65±10.63) min. The separation time of the anterior rectal space was (35.65±3.73) min, and the separation of apical part of the prostate was (6.60±1.54) min. The bleeding volume was (258.60±33.33) mL, and there were no postoperative rectal complications. In comparison between the two groups, the transperineal group was better than the transrectal group in terms of operative time, time to separate the anterior rectal space and bleeding volume, and there was statistical significance (P< 0.05).Conclusion There was no significant difference between the two types of puncture biopsy in the success rate of radical prostate cancer surgery or the rate of rectal injury. However, transperineal prostate puncture biopsy is less disruptive to the anterior rectal space, so it shortens the time to separate the anterior rectal space, shortens the total operative time, reduces operative bleeding, decreases the difficulty of the procedure.
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表 1 两组患者一般资料比较
X±S 组别 身高/cm 年龄/岁 体重/kg 前列腺体积/g TPSA/(ng·mL-1) 经会阴组 170.40±2.74 73.50±3.16 66.41±5.14 51.55±6.53 10.95±2.54 经直肠组 170.65±1.81 72.65±2.60 67.45±5.07 53.65±6.49 11.15±2.41 t/χ2 -0.33 0.95 -0.66 -1.05 -0.26 P值 0.74 0.35 0.51 0.30 0.80 
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表 2 两组患者手术情况比较
项目 经会阴组(n=22) 经直肠组(n=20例) χ2 Fisher精确检验值 P值 术后病理分期 1=54.5%，2=45.5% 1=50.0%，2=50.0% 0.087a) - 0.768 术后切缘情况 1=95.5%，2=0.5% 1=90.0%，2=10.0% - -b) 1.000 注：a)0个单元格(0)的期望计数小于5，最小期望计数为9.52；b)2个单元格(50.0%)的期望计数小于5，最小期望计数为1.43。
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