摘要目的 探讨根治性前列腺切除术后行大组织切片检查在前列腺癌诊断中的意义.方法 回顾性分析我院2015年7月至2018年4月行根治性前列腺切除术的210例患者的临床资料,根据术后病理切片方式分为两组,其中行大组织切片检查者为观察组,行常规组织切片检查者为对照组.观察组60例,年龄(69.0±5.0)岁;体重指数(23.0±1.2) kg/m2;PSA(18.8±2.5)ng/ml;术前Gleason评分(7.9±0.9)分;临床分期cT1～T2期51例(85.0％),cT3期9例(15.0％).对照组150例,年龄(70.0±7.0)岁;体重指数(22.8 ±0.6) kg/m2;PSA(19.3±2.1) ng/ml;术前Gleason评分(7.7±1.6)分;临床分期cT1～T2期137例(91.3％),cT3期13例(8.7％).两组术前一般资料的比较差异均无统计学意义(P＞0.05).比较两组术后Gleason评分、切缘阳性、精囊侵犯、微小病灶、淋巴结转移情况和病理分期的差异.结果 观察组手术时间中位值为138.2 min(119.5～234.1 min),前列腺体积中位值为45.2 m1(18.3～ 121.5 ml)ml;对照组手术时间中位值为133.5 min(116.8～228.2 min),前列腺体积中位值为47.1 ml(21.3～124.2 ml),两组差异均无统计学意义(P＞0.05).观察组术后病理提示精囊侵犯17例(28.3％);淋巴结转移6例(10.0％);病理分期pT2～T3期57例(95.0％),pT4期3例(5.0％);术后Gleason评分为(7.7±1.0)分.对照组术后病理提示精囊侵犯8例(5.3％);淋巴结转移8例(5.3％);病理分期pT2～T3期145例(96.7％),pT4期5例(3.3％);术后Gleason评分(8.0±0.9)分.两组患者精囊侵犯、淋巴结转移、病理分期及术后Gleason评分的比较差异均无统计学意义(P＞0.05).观察组28例(46.7％)切缘阳性,对照组23例(15.3％),两组比较差异有统计学意义(P＜0.01).观察组和对照组分别有22例(36.7％)和7例(4.7％)发现微小病灶,差异有统计学意义(P＜0.01).观察组17例(28.3％) Gleason评分升高,对照组为31例(20.7％),差异无统计学意义(P=0.232).结论 大组织切片技术在根治性前列腺切除术病理诊断中可有效提高切缘阳性和微小病灶检出率,为患者术后治疗和随访提供精准的病理依据.

abstractsObjective To investigate the significance of whole mount sections after radical prostatectomy in the diagnosis of prostate cancer.Methods The data of 210 patients with radical prostatectomy in the Department of Urology of Northern Jiangsu People's Hospital from April 2018 to July 2015 were collected,of which 150 cases (control group) were examined with routine tissue section examination and 60 cases (study group) were examined with whole mount sections.The age of the study group and the control group were (69.0 ± 5.0) years and (70.0 ± 7.0) years respectively,and PSA was (18.8 ± 2.5) ng/ml and (19.3 ± 2.1) ng/ml respectively.The BMI of the study group was (23.0 ± 1.2) kg/m2,and the control group was (22.8 ± 0.6) kg/m2.The preoperative Gleason score of the study group and the control group were 7.9 ±0.9 and 7.7 ± 1.6 respectively.There were 137 patients (91.3％) with clinical stage cT1-T2 and 13 patients with cT3(8.7％) in control group.In the study group,there were 51 cases (85.0％) with clinical stage cT1-T2,and 9 cases with cT3 (15.0％).There was no significant difference between the two groups (P ＞ 0.05) in term of the patients' demographics.The postoperative Gleason score,positive surgical margin,seminal vesicle invasion lymph node metastasis and pathological stage were compared between the two groups.Results The median prostate volume of the study group was 45.2 (18.3-121.5) ml,and 47.1 (2 1.3-124.2) ml in the control group.The operation time of the study group was 138.2 (119.5-234.1) mins,and 133.5 (116.8-228.2) mins in the control group.In the control group,there were 8 cases(5.3％) with seminal vesicle invasion,and 8 cases (5.3％) with lymph node metastasis.The pathological stages were pT2-T3 in 145 cases(96.7％),and pT4 in 5 cases (3.3％) in control group.The postoperative Gleason score was 8.0 ± 0.9 in control group.In the study group,17 patients (28.3％) with seminal vesicle invasion were pathologically indicated,and there were 6 patients (10.0％) with lymph node metastasis.The pathological stages were pT2-T3 of 57 cases(95.0％),and pT4 of 3 cases (5.0％),postoperative Gleason score was 7.7 ± 1.0 in study group.There was no statistically significant difference in seminal vesicle invasion,lymph node metastasis,pathological stage and postoperative Gleason score between the two groups (P ＞ 0.05).There were 23 patients (15.3％) with positive margins in the control group,and 28 patients(46.7％) in the study group,which showed significant difference (P ＜0.01).For small lesions,there were 7 cases (4.7％) and 22 cases (36.7％) in the control group and the study group,respectively,which showed significant difference (P ＜ 0.01).There were 17 cases (28.3％) of increased Gleason score in the study group,while 31 cases (20.7％) in the control group,with no statistical difference (P =0.232).Conclusions The whole mount section technique can effectively improve the positive surgical margin and the small lesions detection rate in the pathological evaluation of radical prostatectomy,and provide a precise pathological diagnosis for the postoperative treatment and follow-up of the patients.