腹腔镜前列腺癌根治术治疗前列腺癌的短期疗效及对患者血清PSA、VEGF、IGF-I和FPSAR水平的影响
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摘要
目的探究腹腔镜前列腺癌根治术治疗前列腺癌的短期疗效及血清前列腺特异性抗原(PSA)、血管内皮生长因子(VEGF)及胰岛素样生长因子I(IGF-I)水平的影响。方法随机数字表格法将120例前列腺癌患者分为试验组与对照组,各60例,分别行腹腔镜前列腺癌根治术、开放性根治术。评价两组手术指标(手术时间、术中出血量、肠道功能恢复时间、住院时间)、疗效指标[国际前列腺症状评分(IPSS)、最大尿流率、残余尿量]及并发症情况,术前、术后1周测定各组血清总前列腺特异抗原(t-PSA)、游离前列腺特异抗原(f-PSA)、VEGF及IGF-I水平,计算f-PSA/t-PSA比值(即FPSAR)。结果手术时间试验组比对照组显著延长,术中出血量、肠道功能恢复时间、住院时间及并发症发生率比对照组均显著减少,差异有统计学意义(P <0.05);与术前比较,两组术后t-PSA、f-PSA、VEGF、IGF-I水平均显著降低,FPSAR显著上升,差异有统计学意义(P <0.05);术后1周IPSS评分、最大尿流率、残余尿量、t-PSA、f-PSA、VEGF、IGF-I、FPSAR比较差异均无统计学意义(P>0.05)。结论腹腔镜前列腺癌根治术能明显降低前列腺癌患者血清PSA、VEGF、IGF-I水平,提高FPSAR比值,短期疗效与开放性根治术相当,但腹腔镜手术相比开放性手术术中出血量少、术后恢复快、并发症少、住院时间短。
Objective To explore the short-term curative effect of laparoscopic radical prostatectomy in the treatment of prostate cancer and the influence on serum prostate specific antigen(PSA), vascular endothelial growth factor(VEGF) and insulin-like growth factor I(IGF-I) levels. Methods 120 patients with prostate cancer were divided into experimental group and control group by random number table method, with 60 cases in each group. The two groups were treated by laparoscopic radical prostatectomy or open radical resection,respectively. Operative indexes( operative time, intraoperative blood loss, intestinal function recovery time,hospital stay),curative effect indexes [International Prostate Symptom Score(IPSS),the maximum flow rate,residual urine volume] and complications in the two groups were evaluated. Levels of serum total prostate specific antigen(t-PSA),free prostate specific antigen(f-PSA), VEGF and IGF-I were determined before operation and at 1 week after operation. The ratio of f-PSA/t-PSA(FPSAR) was calculated. Results The operative time of the experimental group was significantly longer than that of the control group, while the intraoperative blood loss, intestinal function recovery time, hospital stay and the incidence of complications were significantly less/shorter/lower than those in the control group(P <0.05). After operation, levels of tPSA,f-PSA, VEGF and IGF-I in the two groups were decreased significantly while FPSAR increased significantly(P <0.05). There was no significant difference in the IPSS score,the maximum urine flow rate,residual urine volume, t-PSA, f-PSA, VEGF, IGF-I or FPSAR at 1 week after operation(P >0. 05).Conclusion The laparoscopic radical prostatectomy can significantly downregulatelevels of serum PS A, VEGF and IGF-I in patients with prostate cancer and improve the FPSAR ratio. The short-term curative effect is similar to open radical operation. However,compared with open operation,the blood loss during laparoscopic operation is less,patients undergoing laparoscopic operation can recover more quickly,and complications are fewer and hospital stay is shorter.
Objective To explore the short-term curative effect of laparoscopic radical prostatectomy in the treatment of prostate cancer and the influence on serum prostate specific antigen(PSA), vascular endothelial growth factor(VEGF) and insulin-like growth factor I(IGF-I) levels. Methods 120 patients with prostate cancer were divided into experimental group and control group by random number table method, with 60 cases in each group. The two groups were treated by laparoscopic radical prostatectomy or open radical resection,respectively. Operative indexes( operative time, intraoperative blood loss, intestinal function recovery time,hospital stay),curative effect indexes [International Prostate Symptom Score(IPSS),the maximum flow rate,residual urine volume] and complications in the two groups were evaluated. Levels of serum total prostate specific antigen(t-PSA),free prostate specific antigen(f-PSA), VEGF and IGF-I were determined before operation and at 1 week after operation. The ratio of f-PSA/t-PSA(FPSAR) was calculated. Results The operative time of the experimental group was significantly longer than that of the control group, while the intraoperative blood loss, intestinal function recovery time, hospital stay and the incidence of complications were significantly less/shorter/lower than those in the control group(P <0.05). After operation, levels of tPSA,f-PSA, VEGF and IGF-I in the two groups were decreased significantly while FPSAR increased significantly(P <0.05). There was no significant difference in the IPSS score,the maximum urine flow rate,residual urine volume, t-PSA, f-PSA, VEGF, IGF-I or FPSAR at 1 week after operation(P >0. 05).Conclusion The laparoscopic radical prostatectomy can significantly downregulatelevels of serum PS A, VEGF and IGF-I in patients with prostate cancer and improve the FPSAR ratio. The short-term curative effect is similar to open radical operation. However,compared with open operation,the blood loss during laparoscopic operation is less,patients undergoing laparoscopic operation can recover more quickly,and complications are fewer and hospital stay is shorter.
引文
[1] BOSEO C, GARMO H, ADOLFSSON J, et al. Prostate cancer radiation therapy and risk of thromboembolic events[J]. Int J Radiat Oncol Biol Phys,2017,97(5):1026-1031.
[2]刘峰,陈冬,贤少忠,等.腹腔镜下前列腺癌根治术与开放性手术的治疗效果对比分析[J].癌症进展,2016,14(3):232-235.
[3]逄琳,陈新,王艳,等.F-PSA/T-PSA联合MRI在前列腺癌诊断中的应用价值[J].实用癌症杂志,2016,31(4):635-637.
[4]孙玲芬,张瑾. VEGF、IGF-I和f-PSA联检在前列腺癌诊断中的临床意义[J].放射免疫学杂志,2013,26(2):212-213.
[5]汪峰,强亚勇,张斌斌,等.腹腔镜前列腺癌根治术治疗前列腺癌的疗效及对患者血清激素水平的影响[J].现代生物医学进展,2017,17(24):4710-4713,4774.
[6] PATERSON C,MCLUCKIE S,YEW-FUNG C,et al. Videotaping of surgical procedures and outcomes following extraperitoneal laparoscopic radical prostatectomy for clinically localized prostate cancer[J]. J Surg Oncol,2016,114(8):1016-1023.
[7]李英,黄松芳,刁秀琳,等.经腹膜外人路腹腔镜前列腺癌根治术的手术配合[J].护士进修杂志,2015,30(19):1800-1801.
[8]黄勇,罗俊航,莫承强,等.机器人辅助前列腺瘤根治术和腹腔镜前列腺癌根治术的回顾性比较[J].中华腔镜泌尿外科杂志(电子版),2017,11(2):4-8.
[9]张江磊,曹志骏,臧晋,等.腹膜外人路腹腔镜治疗前列腺癌的疗效及对免疫功能的影响[J].贵州医药,2017,41(11):1172-1174.
[10]李志坤,汤磊,赵亚伟,等.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[J].中国医药导报,2017,14(20):105-108.
[11]郑伟,薛超辉,雷毅,等.腹腔镜下根治术对早期前列腺癌近期效果及尿流动力学远期影响[J].陕西医学杂志,2017,46(9):1202-1205.
[12]张明艳,韩起鹏,关小川,等.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[J].疑难病杂志,2017,16(8):817-820,829.
[13] LIU J J,BROOKS J D,FERRARI M,et al. Performance characteristics of PSA in patients undergoing radical prostatectomy[J]. J Clin Oncol,2012,30(5):199.
[14]张华,钟白云,王新华,等.血清t-PSA及f-PSA/t-PSA联合诊断前列腺癌的价值评价[J].中国现代医学杂志,2014,24(7):24-27.
[15]夏中友,伍季,张萌,等.前列腺癌组织中ING4与VEGF的表达及相关性研究[J].西部医学,2017,29(2):187-191,195.
[16] RADDAM A W, ALLEN N E, APPLEBY P, et al. Insulin-like growth factors, their binding proteins, and prostate cancer risk analysis of individual patient data from 12 prospective studies[J].Ann Item Med,2008,149,(7):461-471.
[2]刘峰,陈冬,贤少忠,等.腹腔镜下前列腺癌根治术与开放性手术的治疗效果对比分析[J].癌症进展,2016,14(3):232-235.
[3]逄琳,陈新,王艳,等.F-PSA/T-PSA联合MRI在前列腺癌诊断中的应用价值[J].实用癌症杂志,2016,31(4):635-637.
[4]孙玲芬,张瑾. VEGF、IGF-I和f-PSA联检在前列腺癌诊断中的临床意义[J].放射免疫学杂志,2013,26(2):212-213.
[5]汪峰,强亚勇,张斌斌,等.腹腔镜前列腺癌根治术治疗前列腺癌的疗效及对患者血清激素水平的影响[J].现代生物医学进展,2017,17(24):4710-4713,4774.
[6] PATERSON C,MCLUCKIE S,YEW-FUNG C,et al. Videotaping of surgical procedures and outcomes following extraperitoneal laparoscopic radical prostatectomy for clinically localized prostate cancer[J]. J Surg Oncol,2016,114(8):1016-1023.
[7]李英,黄松芳,刁秀琳,等.经腹膜外人路腹腔镜前列腺癌根治术的手术配合[J].护士进修杂志,2015,30(19):1800-1801.
[8]黄勇,罗俊航,莫承强,等.机器人辅助前列腺瘤根治术和腹腔镜前列腺癌根治术的回顾性比较[J].中华腔镜泌尿外科杂志(电子版),2017,11(2):4-8.
[9]张江磊,曹志骏,臧晋,等.腹膜外人路腹腔镜治疗前列腺癌的疗效及对免疫功能的影响[J].贵州医药,2017,41(11):1172-1174.
[10]李志坤,汤磊,赵亚伟,等.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[J].中国医药导报,2017,14(20):105-108.
[11]郑伟,薛超辉,雷毅,等.腹腔镜下根治术对早期前列腺癌近期效果及尿流动力学远期影响[J].陕西医学杂志,2017,46(9):1202-1205.
[12]张明艳,韩起鹏,关小川,等.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[J].疑难病杂志,2017,16(8):817-820,829.
[13] LIU J J,BROOKS J D,FERRARI M,et al. Performance characteristics of PSA in patients undergoing radical prostatectomy[J]. J Clin Oncol,2012,30(5):199.
[14]张华,钟白云,王新华,等.血清t-PSA及f-PSA/t-PSA联合诊断前列腺癌的价值评价[J].中国现代医学杂志,2014,24(7):24-27.
[15]夏中友,伍季,张萌,等.前列腺癌组织中ING4与VEGF的表达及相关性研究[J].西部医学,2017,29(2):187-191,195.
[16] RADDAM A W, ALLEN N E, APPLEBY P, et al. Insulin-like growth factors, their binding proteins, and prostate cancer risk analysis of individual patient data from 12 prospective studies[J].Ann Item Med,2008,149,(7):461-471.
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