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前列腺尖部形态对腹腔镜根治性前列腺切除术后尖部切缘阳性及生化复发的影响

Impact of diverse shapes of prostatic apex on positive apical margin rate and biochemical recurrence following laparoscopic radical prostatectomy
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摘要 目的探讨前列腺尖部形态与腹腔镜根治性前列腺切除术后尖部切缘阳性的关系及其对生化复发的影响。方法回顾性分析福建医科大学附属第一医院泌尿外科2010年1月至2016年12月收治的309例腹腔镜根治性前列腺切除术患者的资料。患者年龄(65±6)岁。根据术前MRI前列腺形态分为4组:前列腺组织覆盖膜部尿道前部和后部为1型(31例),只覆盖膜部尿道前部为2型(139例),只覆盖膜部尿道后部为3型(63例),均不覆盖为4型(76例)。采用χ^2检验比较各型尖部切缘阳性率,Logistic回归分析尖部切缘阳性的相关因素,Cox比例风险模型分析术后生化复发的预后因素。结果四组基本资料具有可比性(P>0.05)。术后随访12~60个月,中位随访32个月。3型术后尖部切缘阳性率高,4组差异有统计学意义(χ^2=15.592,P=0.001)。术前前列腺特异抗原(PSA)(OR=20.356,95%CI:2.440~169.810,P=0.005)、术后Gleason评分(OR=4.113,95%CI:1.911~8.849,P=0.001)、术后病理学分期(OR=3.422,95%CI:1.600~7.319,P=0.002)及3型尖部形态(OR=6.134,95%CI:2.196~17.132,P=0.001)是尖部切缘阳性的独立相关因素。术前PSA(HR=1.362,95%CI:1.006~1.843,P=0.045)、术后Gleason评分(HR=1.920,95%CI:1.384~2.665,P=0.001)、术后病理学分期(HR=1.476,95%CI:1.098~1.983,P=0.010)、尖部切缘阳性(HR=3.497,95%CI:2.407~5.081,P=0.001)及3型尖部形态(HR=1.828,95%CI:1.266~2.639,P=0.001)是生化复发的独立预后因素。结论3型前列腺尖部形态为根治性前列腺切除术后尖部切缘阳性的独立相关因素,是术后生化复发的独立预后因素。 Objective To explore the effects of various forms of prostatic apex on positive apical margin rate (PAM) and biochemical recurrence (BCR) after laparoscopic radical prostatectomy. Methods A retrospective analysis of 309 patients (aging (65±6) years) who were experienced laparoscopic radical prostatectomy from January 2010 to December 2016 at the Department of Urology, First Affiliated Hospital of Fujian Medical University. According to the relationship between prostate apex and membrane urethra at the mid-sagittal plane of preoperative MRI, all patients were classified into 4 categories. There were 31 patients for type 1, apex covering both anterior and posterior aspects of membranous urethra, 139 patients for type 2, apex covering anterior side of membranous urethra, 63 patients for type 3, apex covering posterior aspect of membranous urethra, 76 patients for type 4, apex not covering membranous urethra. PAM and BCR after operation were compared between this four groups respectively. The χ^2 test was used to compare PAM among the 4 types. Logistic regression analysis were undertaken to analyze the factors affecting PAM. Cox′s proportional hazards regression model was undertaken to identify the variables influencing BCR. Results There was no significant difference in the 4 groups concerning age, body mass index, prostate volume, preoperative prostate-specific antigen (PSA) value, postoperative Gleason score and pathological stage (P>0.05).The median follow-up time was 32 months (ranged from 12 to 60 months).The data showed that the apical type 3 patients has the highest PAM. There was statistical difference among the 4 groups in PAM (χ^2=15.592, P=0.001). Preoperative level of PSA (OR=20.356, 95% CI: 2.440 to 169.810, P=0.005), postoperative Gleason score (OR=4.113, 95% CI: 1.911 to 8.849, P=0.001), pathological stage (OR=3.422, 95% CI: 1.600 to 7.319, P=0.002) and apical type 3 (OR=6.134, 95% CI: 2.196 to 17.132, P=0.001) were independent relactive factors of PAM. Preoperative level of PSA (HR=1.362, 95% CI
作者 梁迎春 许宁 吴宇鹏 陈东宁 魏勇 薛学义 黄金杯 郑清水 Liang Yingchun;Xu Ning;Wu Yupeng;Chen Dongning;Wei Yong;Xue Xueyi;Huang Jinbei;Zheng Qingshui(Department of Urology, First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China)
出处 《中华外科杂志》 CAS CSCD 北大核心 2019年第3期200-205,共6页 Chinese Journal of Surgery
基金 福建省医学创新课题(2016-CX-27) 福建省自然科学基金(2017J01197).
关键词 前列腺癌 前列腺切除术 肿瘤 残余 Prostate neoplasms Prostatectomy Neoplasm, residual
作者简介 通信作者:郑清水,Email:zhengqingshui@ljniu.edu.cn,电话:0591-87981687.
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