22例耻骨后前列腺癌根治术减少并发症的探讨  

Study on Reduction of Complications in Radical Retropubic Prostatectomy of 22 Cases

作　　者：柯昌兴[1] 王剑松[1] 石永福[1] 左毅刚[1] 杨德林[1] 徐鸿毅[1] 

机构地区：[1]昆明医学院第二附属医院泌尿外科,云南昆明650101

出　　处：《昆明医学院学报》2007年第1期67-70,共4页Journal of Kunming Medical College

基　　金：云南省科技攻关项目(2002NG18)

摘　　要：目的探讨耻骨后前列腺癌根治术(RRP)的手术技巧,减少并发症的发生.方法对22例前列腺癌患者(平均年龄67岁,B期19例,C期3例)实施耻骨后前列腺根治术,术中妥善处理阴茎背静脉复合体,保护耻骨前列腺韧带、耻骨直肠悬带、神经血管束、尿道外括约肌、重建膀胱颈等.结果22例患者手术顺利并康复出院,随访1-4 a,平均16个月,2例死亡,其余均生存.手术时间90-220 min,平均140 min;术中失血250-1 500 mL,平均600 mL,6例患者未输血,16例患者输血300-1 200 mL;术中未发生直肠、输尿管等损伤并发症.术后2-3周拔除导尿管,3个月后2例有压力性尿失禁,1例尿道狭窄经尿道扩张后小便通畅,术后15例有阴茎勃起功能;随访期间生化复发3例并行间隙化疗,其余病例无生化复发.结论按正确的解剖层次操作,减少前列腺尖部及其周边组织的破坏,并行膀胱颈重建可以降低并发症,取得较好的手术效果.Objective To evaluate the effect of technical improvement of radical retropubic prostatectomy （RRP） for patients and reduction of complications. Methods age 67 years, stage B 19 cases, stage C 3 cases） underwent the dorsal vein complex, puboprostatic ligament, puborectalis 22 patients with clinically prostate cancer （mean radical retropubic prostatectomy. During operation sling, the neurovascular bundle, external urethral sphincter, reconstruction of the bladder neck were carefully managed. Results All the patients recovered uneventful except 2 deaths, and they survived and were followed up for a mean time of 16 months （range 1 - 4 years）. The mean operative time was 140 minutes （range 90 - 220 minutes） and the mean blood loss was 600 mL （ range 250 - 1 500 mL）. 16 cases received blood transfusion for 300- 1 200 mL and no ureteral or rectal injury occurred. The urinary catheters were removed 2 - 3 weeks after operation. 2 cases had stress incontinence 3 months later, 1 case encountered urethral stricture and became well after Urethral dilation, 15 cases had satisfactory erectile function after operation and 3 patients had biochemical failure and endured continually chemotherapy during follow -up. Conclusions Accurate maneuver is handled according to correct anatomy can protect the apex of prostate and its surrounding tissue and reconstructing the bladder neck is helpful to reduce complications and achieve better outcome.

关 键 词：前列腺肿瘤 癌 根治术 并发症 

分 类 号：R737.25[医药卫生—肿瘤]