前列腺癌患者经腹膜外入路行改良单孔腹腔镜手术治疗对tPSA、fPSA及机体免疫指标的影响

摘要

Objective To investigate the effect of extraperitoneal approach on tPSA,fPSA and immune index in patients with prostate cancer undergoing modified single hole laparoscopic surgery.Methods Ninety cases of patients with prostate cancer were selected,who were treated in hospital from January 2010 to January 2017,and they were divided into the observation group(45 cases)and control group(45 cases).The patients in observation group were treated with extraperitoneal approach modified single hole laparoscopic surgery,while the patients in control group were treated with intraperitoneal approach modified single hole laparoscopic surgery.After surgery,the patients of two groups were all treated with enhance-nutritional support,conventional anti-infective,added intravenous blood volume,and ensure smooth drainage of the catheter.The operation time,recovery time of gastrointestinal function,intraoperative blood loss,length of hospital stay were compared,followed up of 1 to 6 months,postoperative complications and changes of the levels of IgG,IgA,IgM,C3,C4,tPSA,fPSA,CD3+,CD4+,CD8+of two groups were compared.Results The operation time,recovery time of gastrointestinal function,intraoperative blood loss,length of hospital stay of the observation group were significantly lower than those of the control group(x2=1.742,x2=3.989,x2=5.190,x2=2.939,P=0.042,P=0.000,P=0.000,P=0.002);The levels of IgG,IgA,C3,C4,CD3+,CD4+,CD4/CD8 decreased in the first day after operation(P<0.01),the levels of IgG,IgA,C3,C4,CD3+,CD4+,CD4/CD8 were significantly increased in the 7th day after operation,CD8 levels significantly decreased(P<0.01),while IgM levels had no significant change(P>0.05);The magnitude of the rise of observation group was significantly higher than the control group(P<0.05),CD8 decreased significantly lower than the control group(P<0.01);The levels of tPSA and fPSA in the observation group were significantly lower than those in the control group on the 1st and 7th day after operation(P<0.01);There were pelvic hematoma,urethral stricture,stress urinary incontinence,urinary retention and unilateral inguinal hernia occurred in both two groups in the follow up of 1 to 6 months,and the incidence in the observation group were significantly lower than the control group(x2=4.282,x2=6.932,x2=4.499,x2=4.909,x2=6.379,P=0.039,P=0.008,P=0.034,P=0.027,P=0.011).Conclusion The modified single hole laparoscopic surgery for the treatment of prostate cancer is effective and minimally invasive,and it is beneficial to protect the immune function of patients with less complications and good safety.%目的 观察前列腺癌患者经腹膜外入路行改良单孔腹腔镜手术治疗对前列腺特异性抗原及机体免疫指标的影响.方法 选择2010年1月-2017年1月解放军第202医院泌尿外科治疗前列腺癌患者90例作为研究对象,按随机数字表法分为2组,每组45例.观察组采用腹膜外入路行改良单孔腹腔镜前列腺癌根治术,对照组采用腹腔入路改良单孔腹腔镜前列腺癌根治术,2组患者术后均加强营养支持,常规抗感染,给予静脉补充血容量,保证尿管引流通畅.比较2组患者手术时间、肠胃功能恢复时间、术中出血量、住院时间;分别于术前及术后第1天、第7天检测IgG、IgA、IgM、C3、C4、总前列腺特异性抗原(tPSA)、游离前列腺特异性抗原(fPSA)、CD3+、CD4+、CD8+水平;术后随访并记录2组患者并发症发生情况.结果 观察组手术时间、肠胃功能恢复时间、术中出血量、住院时间明显短于/低于对照组(x2=1.742、3.989、5.190、2.939,P =0.042、0.000、0.000、0.002);术后第1天2组患者IgG、IgA、C3、C4、CD3+、CD4+、CD4+/CD8+水平均呈降低趋势,CD8+上升,术后第7天,CD8+均降低,而其余各指标均升高(P <0.01),而IgM无明显变化(P >0.05);其中观察组各指标改善均优于对照组,差异具有统计学意义(P <0.05);2组术后第1天、第7天 tPSA、fPSA水平明显降低,且观察组明显低于对照组(P <0.01).2组患者随访1～6个月,观察组发生盆腔血肿、尿道狭窄、压力性尿失禁、尿潴留及单侧腹股沟疝等并发症发生率明显低于对照组(x2=4.282、6.932、4.499、4.909、6.379,P =0.039、0.008、0.034、0.027、0.011).结论 经腹膜外入路行改良单孔腹腔镜手术治疗前列腺癌患者疗效确切,手术创伤小,有利保护患者免疫功能,并发症少,安全性好.