根治的前立腺全摘除術における骨盤計測を用いた術中出血量の予測

Abstract

2004年4月～2006年3月に単一術者による恥骨後式前立腺全摘除術を受けた39例(年齢61～77歳)を対象に検討した。術中出血量は平均761ml(232～2149ml)で同種血輸血を必要とした症例はなかった。術中出血量と骨盤入口部の広さ(APE)とBMIの関連をCut off値125とした分類で検討した結果, 手術時年齢, 治療前PSA, 摘出前立腺量, 病理組織学的T分類, 術前分泌療法の有無と出血量の関連性は低く, APE, 前立腺尖部の視野評価(VPA), BMIにおいて有意差が認められた。APEが125未満, VPAが不良, BMIが25以上は術中出血量に対し不利な因子と考え, この因子を有さない群の出血量は少なく最大でも650mlであった。以上から, 術前画像による視野評価を含めた骨盤計測は術中出血量予測に有用と考えられた。

We retrospectively evaluated the possibility of predicting estimated blood loss (EBL) in 39 consecutive patients undergoing retropubic radical prostatectomy (RRP) using pelvimetry under a single surgeon at our institution from April 2004 to March 2006. For pelvimetry, the area of pelvic entrance (APE) and view of prostatic apex (VPA) were evaluated using preoperative images. Other perioperative data were also recorded, including the patient's age, prostate specific antigen (PSA), body mass index (BMI), use of neoadjuvant hormonal therapy, operative time and pathological data (such as pathological T factor and specimen weight). The relationship between these factors and EBL was analyzed. Average EBL was 761 ml (ranging from 232 to 2, 149) and autologous blood transfusion was not performed. There was no statistically significant correlation or difference between EBL and perioperative parameters excluding APE, VPA and BMI. Multivariate analysis showed that the most influential factor for EBL was VPA (p = 0.001). A significantly lower EBL was seen in patients with a wide APE (125 or more), good VPA, and acceptable BMI (less than 25 kg/m2) versus other patients (429 +/- 137 ml vs 934 +/- 358 ml, p < 0.0001). Our findings demonstrate the potential of pelvimetric analysis such as the measurement of APE and the evaluation of VPA, as a useful tool for predicting blood loss during RRP. Moreover, these data also indicate that blood preparation may be spared in patients with acceptable BMI, wide APE, and good VPA.