经尿道前列腺剜除术中对前列腺包膜和外科包膜性状的观察  

The character of the surgical capsule and the prostatic capsule in PKEP

作　　者：陈向东[1] 王忠[2] 齐隽[3] 

机构地区：[1]上海市静安区中心医院泌尿外科,上海200040 [2]上海交通大学医学院附属第九人民医院泌尿外科 [3]上海交通大学医学院附属新华医院泌尿外科

出　　处：《中国男科学杂志》2009年第5期43-45,52,共4页Chinese Journal of Andrology

基　　金：上海市卫生局申康医院发展中心"上海市良性前列腺增生症社区综合防治规范模式的探索与推广"项目资助;项目批准号:SHDCI2007313

摘　　要：目的探讨在经尿道前列腺切除术(TURP)术中正确识别外科包膜作为手术界限的意义。方法良性前列腺增生症(BPH)手术病人32例。应用等离子体切割系统(PKS)及内窥镜手术设备,视频监视系统。等离子体切割系统经尿道前列腺剜除术(PKEP)完成后彻底止血以清楚显示外科包膜。使用电切环在不同的选择点(截石位5',7',3',9'1',11')由浅入深切开外科包膜与前列腺包膜至脂肪组织。观察切开的创面。以电切环为参照物测量切开组织的厚度。结果58个切口。外科包膜外观平坦,质地均匀,外科包膜切开面缺乏典型腺瘤组织"面包渣样"外观,平均厚度(3.75±1.41)mm。而前列腺包膜则外观呈粗网状、反光强的平滑肌肌束,平均厚度(1.17±0.33)mm。并可见有细的肌束交织状进入外科包膜,但分界不明显。在一些位置前列腺包膜稀疏甚至不能与前列腺周围脂肪组织形成明确分隔。结论应用TURP治疗BPH应以外科包膜内侧面作为手术界限,而前列腺包膜很难安全地作为TURP的手术界限。Objective To understand the character of the surgical capsule and the prostatic capsule in TURP. Methods Total of 32 BPH patients were enrolled in this study. Gyrus-PKS, resectscope and video record system were used for obervation of surgical capsule and prostatic capsule, we completed all PKEP and then stoped bleeding in operative field so as to display the surgical capsule clearly. Using cutting loop, from superficial to deeper, the surgical capsule and prostatic capsule were cut until seeing the exterior fat at some selected sites （5＇,7＇3＇,9＇ 1＇,11＇, in lithotomy position）. The character and the thickness of the cuts were measured and recorded. Results Fifty-eight cuts were gotten on the inner surface of the surgical capsule in all 32 cases. The appearance of the surgical capsule was fiat. The cuts on the surgical capsule were lack of the typical ＂bread-like＂ appearance of adenoma tissue. The mean thickness of the surgical capsule was （3.75±1.41）mm. The appearance of the prostatic capsule was ＂lace texture＂ like and glistening more strongly. The mean thickness of the prostatic capsule was （1.17±0.33）mm. It was observed that the inner surface of prostatic capsule gives rise to a few bundles of fibromuscular stroma that penetrate and disappear into the surgical capsule, and inseparable. At some site, the appearance of the prostatic capsule was so sparse that lacking of a definite boundary between the periprostatic connective tissue and the surgical capsule. Conclusion The inner surface of the surgical capsule might be a operative limit for BPH in TURP, but no evidence was found for prostatic capsule as safe boundary for BPH in TURP.

关 键 词：前列腺增生 外科包膜 前列腺包膜 经尿道前列腺切除术 

分 类 号：R699[医药卫生—泌尿科学]