| 摘要: |
| 目的 比较单术者应用机器人辅助与开放前列腺癌根治术两种手术方式进行前列腺癌切除时肿瘤切缘阳性情况。方法 2009年1月至2017年5月期间，我院单术者分别应用开放前列腺癌根治术治疗的81例前列腺癌患者及机器人辅助前列腺癌根治术治疗的306例前列腺癌患者入组本研究。术后病理切缘阳性定义为前列腺癌根治标本切缘墨染标记处可见肿瘤细胞。通过我科前列腺癌随访数据库提取所有患者的年龄、术前前列腺特异抗原（PSA）水平、术后病理Gleason评分、病理T分期、上下切缘阳性情况等资料，使用倾向评分匹配法对两种术式的数据进行配对以保证其一致性，比较两种术式切缘阳性情况的差异。采用多因素logistic回归分析明确切缘阳性的独立影响因素。结果 将两组患者的年龄、术前PSA水平、术后病理Gleason评分、病理T分期作为预测变量进行倾向评分匹配后成功配对81对病例，开放前列腺癌根治术组和机器人辅助前列腺癌根治术组上切缘阳性率分别为22.2%（18/81）、18.5%（15/81），下切缘阳性率分别为29.6%（24/81）、30.9%（25/81），总切缘阳性率分别为38.3%（31/81）、38.3%（31/81），两组间差异均无统计学意义。多因素logistic回归分析术前PSA水平及病理T分期是切缘阳性的独立影响因素（P=0.011，P=0.000）。结论 机器人辅助前列腺癌根治术能够提供不亚于开放手术的肿瘤切除的完整性。 |
| 关键词: 机器人辅助前列腺癌根治术 开放前列腺癌根治术 单术者 切缘阳性 倾向评分匹配 |
| DOI：10.16781/j.0258-879x.2017.09.1134 |
| 投稿时间：2017-07-03修订日期：2017-09-09 |
| 基金项目: |
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| Positive surgical margins in robot-assisted or open radical prostatectomy:a comparative study |
| SHI Ting,GAO Xu,WANG Hai-feng,WANG Yan,XU Chuan-liang,SUN Ying-hao* |
(Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
*Corresponding author) |
| Abstract: |
| Objective To compare the positive surgical margins of the cases by a single surgeon using open versus robot-assisted radical prostatectomy. Methods We chose one surgeon's 387 eligible cases with prostatic cancer, of whom 81 underwent open radical prostatectomy and 306 underwent robot-assisted radical prostatectomy in Department of Urology of Changhai Hospital of Second Military Medical University from Jan. 2009 to May 2017. A positive surgical margin was defined as the presence of tumor cells at the inked surface of the resected specimen. We collected all patients' data from the prostate cancer follow-up database, including age, pre-operative level of prostate specific antigen (PSA), post-operative pathological Gleason score, pathological T staging, and upper and lower margins status. We used propensity score matching to match the data of two groups to ensure the consistency and finally analyzed the difference of positive surgical margins between the two matched groups. Multivariate logistic regression analysis was used to identify the independent influencing factors of positive surgical margins. Results We successfully matched 81 pairs of cases by propensity score matching using age, pre-operative level of PSA, post-operative pathologic Gleason score and pathological T staging as prediction variables. The positive rates of upper, lower and total surgical margins showed no significant differences between open and robot-assisted radical prostatectomy (upper:22.2%[18/81] vs 18.5%[15/81]; lower:29.6%[24/81] vs 30.9%[25/81]; total:38.3%[31/81] vs 38.3%[31/81]). Multivariate logistic regression analysis showed that pre-operative level of PSA (P=0.011) and pathological T stage (P=0.000) were independent influencing factors of positive surgical margin. Conclusion Robot-assisted and open radical prostatectomies show a similar integrity in radical prostatectomy. |
| Key words: robot-assisted radical prostatectomy open radical prostatectomy single surgeon positive surgical margin propensity score matching |
