腹腔镜经腹膜外入路与开腹前列腺癌根治术治疗前列腺癌效果、术后T淋巴细胞亚群及生活质量比较

摘要

目的 比较腹腔镜经腹膜外入路与开腹前列腺癌根治术治疗前列腺癌效果、术后T淋巴细胞亚群及生活质量.方法 收集2016年1～10月新疆生产建设兵团总医院泌尿外科收治的105例前列腺癌患者作为观察对象,按照手术方式分为开腹组(n=45)和腹腔镜组(n=60).开腹组行开腹前列腺癌根治术,腹腔镜组行腹腔镜下经腹膜外入路前列腺癌根治术.采用国际前列腺症状评分(IPSS)、生活质量核心问卷(QLQ-C30)评分评价症状严重程度和生活质量.比较手术情况、疗效相关指标、T淋巴细胞亚群及生活质量.结果 所有患者均手术成功,开腹组和腹腔镜组术后并发症发生率比较,差异无统计学意义(P＞0.05).术后1个月,IPSS评分、最大尿流率、残余尿量及血清前列腺特异性抗原水平两组比较,差异无统计学意义(P＞0.05).术后1周,与开腹组比较,腹腔镜组患者CD4+、CD4+/CD8+水平升高,CD8+水平降低,差异有统计学意义(P＜0.05).术后1月,与开腹组比较,腹腔镜组患者反映生活质量的角色功能、情绪功能及社会功能评分升高,差异有统计学意义(P＜0.05),而躯体功能和认知功能两组比较,差异无统计学意义(P＞0.05).结论 腹腔镜经腹膜外入路与开腹前列腺癌根治术均是前列腺癌的有效安全手术方式.与开腹手术相比,腹腔镜经腹膜外入路前列腺癌根治术对细胞免疫功能影响小,改善生活质量更明显.对于适宜腹腔镜经腹膜外入路前列腺癌根治术患者,可优先选择此手术方式.%Objective To compare the effect,T lymphocyte subsets and quality of life between laparoscopic extraperitoneal radical prostatectomy and prostatectomy by open surgery in patients with prostate cancer.Methods From January to Dctober 2016,in Department of Urology,Xinjiang Production and Construction Corps Hospital,105 patients with prostate cancer were selected,they were divided into the open surgery group (n =45) and the laparoscope group (n =60) according to operation methods.The open surgery group was given prostatectomy by open surgery,the laparoscope group was given laparoscopic extraperitoneal radical prostatectomy.International prostate symptom score (IPSS) and core quality of life questionnaire-30 (QLQ-C30) were employed to assess severity of clinical symptoms and quality of life.Then,the operation status,efficacy-related indices,lymphocyte subsets and quality of life were compared.Results All patients underwent successful operation,and the incidences of postoperative complications in the open surgery group and the laparoscope group were compared,the differences were not statistically significant (P ＞ 0.05).1 month after surgery,scores of IPSS,maximum urine flow rate,residual urine volume and levels of prostate specific antigen of the two groups were compared,the differences were not statistically significant (P ＞ 0.05).Compared with the open surgery group,the laparoscope group had higher levels of CD4+,CD4+/CD8+ and lower level of CD8+,the differences were statistically sig nificant (P ＜ 0.05).1 month after surgery,compared with the open surgery group,scores of role function,emotional function and social function that reflected quality of life in laparoscope group were statistically higher,(all P ＜ 0.05),the differences were statistically significant (P ＜ 0.05).but scores of body function and cognitive function in the two groups were compared,the differences were not statistically significant (P ＞ 0.05).Conclusion Both laparoscopic extraperitoneal radical prostatectomy and prostatectomy by open surgery are effective and safely operation modes for patients with prostate cancer.Compared with open surgery,laparoscopic extraperitoneal radical prostatectomy has less influence on cellular immune function and improves quality of life more after operation.For patients who are suitable for laparoscopic extraperitoneal radical prostatectomy,this operation mode is priority selection.