微创泌尿外科杂志

目的：探究腹腔镜顺行双保前列腺癌根治术(LabNSRP)与腹腔镜前列腺癌根治性切除术(LRP)治疗前列腺癌的临床效果。方法：选取2019年1月至2023年3月广元市第一人民医院216例前列腺癌患者进行研究，按随机数字表法将其分为研究组、对照组，每组108例。对照组行LRP治疗，研究组行LabNSRP治疗。比较两组患者围术期指标、手术前后血清肿瘤标志物[癌胚抗原(CEA)、神经元特异性烯醇化酶(NSE)、前列腺酸性磷酸酶(PAP)、总前列腺特异性抗原(TPSA)、游离前列腺特异性抗原(FPSA)]、免疫功能指标(CD3⁺、CD4⁺、CD4⁺/CD8⁺)、预后相关标志物[颗粒蛋白88(GP88)、磷酸甘油酸激酶1(PGK-1)、α-甲酰辅酶A消旋酶(AMACR)、血小板/淋巴细胞比值(PLR)]、国际前列腺症状评分(IPSS)、生活质量评分(QOL)、国际勃起功能指数(IIEF-5)评分及术后并发症，术后随访12个月，统计比较两组复发率。结果：研究组肠道功能恢复时间[(2.39±0.76)d]短于对照组[(3.24±0.88)d]，差异有统计学意义(P<0.05)；两组手术时间、切缘阳性率、出血量、术后引流量及住院时间比较，差异无统计学意义(P>0.05)；术后第3天，研究组CD3⁺、CD4⁺、CD4⁺/CD8⁺水平高于对照组(P<0.05)；两组术后第1个月外周血PLR及血清AMACR、GP88、PGK-1、PAP、CEA、TPSA、NSE水平比较，差异无统计学意义(P>0.05)；术后第3个月，研究组IPSS评分低于对照组，IIEF-5、QOL评分高于对照组(P<0.05)；术后3个月内，研究组并发症发生率低于对照组(P<0.05)；两组复发率比较，差异无统计学意义(P>0.05)。结论：LabNSRP治疗前列腺癌可有效促进术后控尿能力及勃起功能恢复，减少术后免疫功能紊乱，降低术后并发症发生风险，提高生活质量。

Objective: To explore the clinical efficacy of laparoscopic-assisted nerve-sparing radical prostatectomy(LabNSRP) versus laparoscopic radical prostatectomy(LRP) in the treatment of prostate cancer. Methods: A prospective study was conducted on 216 patients with prostate cancer admitted to Guangyuan First People's Hospital from January 2019 to March 2023. They were divided into a study group and a control group according to the random number table method, with 108 cases in each group. The control group was treated with LRP, and the study group was treated with LabNSRP. The perioperative indicators, serum tumor markers [carcinoembryonic antigen(CEA), neuron-specific enolase(NSE), prostatic acid phosphatase(PAP), total prostate-specific antigen(TPSA), free prostate-specific antigen(FPSA)], immune function indicators(CD3+, CD4+, CD4+/CD8+), prognosis-related markers [granulin 88(GP88), phosphoglycerate kinase 1(PGK-1), α-methylacyl-CoA racemase(AMACR), platelet-to-lymphocyte ratio(PLR)], International Prostate Symptom Score(IPSS), Quality of Life Score(QOL), International Index of Erectile Function-5(IIEF-5) score, and postoperative complications were compared between the two groups. The patients were followed up for 12 months, and the recurrence rates of the two groups were statistically compared. Results: The intestinal function recovery time in the study group [(2.39±0.76) days] was shorter than that in the control group [(3.24±0.88) days], and the difference was statistically significant(P<0.05). There were no statistically significant differences in operation time, positive surgical margin rate, blood loss, postoperative drainage volume, or length of hospital stay between the two groups(P>0.05). On the 3 rd day after surgery, the levels of CD3+, CD4+, and CD4+/CD8+ in the study group were higher than those in the control group(P<0.05). There were no statistically significant differences in peripheral blood PLR and serum levels of AMACR, GP88, PGK-1, PAP, CEA, TPSA, and NSE between the two groups at 1 month after surgery(P>0.05). At 3 months after surgery, the IPSS score in the study group was lower than that in the control group, while the IIEF-5 and QOL scores were higher than those in the control group(P<0.05). Within 3 months after surgery, the incidence of complications in the study group was lower than that in the control group(P<0.05). There was no statistically significant difference in the recurrence rate between the two groups(P > 0.05). Conclusion: LabNSRP in the treatment of prostate cancer can effectively promote the recovery of postoperative urinary control and erectile function, reduce postoperative immune dysfunction, lower the risk of postoperative complications, and improve the quality of life.