双针连续膀胱尿道吻合法在腹腔镜前列腺癌根治术中的应用  

Technique of running urethrovesical anastomosis during radical laparoscopic prostatectomy ： separate application of two needles

作　　者：殷民[1] 杨燮樵[1] 李如兵[1] 杨明[1] 俞振华[1] 林宁殊[1] 

机构地区：[1]浙江省宁波市医疗中心李惠利医院泌尿外科,315040

出　　处：《中华医学杂志》2010年第28期1955-1957,共3页National Medical Journal of China

摘　　要：目的探讨一种简单易行的腹腔镜下膀胱尿道连续吻合法的应用价值。方法我们于2008-2009年对10例早期局限性前列腺癌患者施行腹膜外腹腔镜前列腺癌根治术，术中采用分别置人的双针连续缝合法行膀胱尿道吻合。首先在膀胱颈后壁4点处做全层缝合并打结固定，相应尿道端做由内向外的缝合，5—8点之间每点做连续缝合，以后每2点做顺时针连续缝合，在12点钟处做一锁边缝合，收紧缝线后将缝针置于吻合口左侧。置入另一枚同样缝针，缝合膀胱颈与尿道端3点处并打结后，同样方法每隔一点做逆时针连续缝合，两根缝线在12点处打结。如果出现吻合口漏，加用单纯缝合修补。结果所有吻合均顺利完成。吻合时间25～45min，平均30min。手术时间200～300min，平均220min。尿管留置14d，10例随访3—24个月，未见生化复发，无尿道狭窄病例。结论分别置入的双针连续吻合法简单易学，缝合严密，并发症少，利于初学者的学习。Objective To study the value and feasibility of a novel method of urethrovesical anastomosis during radical laparoscopic prostateetomy. Methods From 2008 to 2009, 10 patients with local prostate cancer （LPC） underwent radical laparoseopic prostateetomy through the placement of two separate needles for running urethrovesical anastomosis. The first step comprised the first stitch placed in the posterior wall of anastomosis （ at 4 o＇clock） and then clockwise running suture from 4 to 12 o＇clock position. The next steps entailed another needle, stitching at 3 o＇ clock position and counterclockwise running suture. Two sutures would meet at 12 o＇clock position for the third and final knot. When the position of urinary leak was observed, an additional suture would be performed. Results This technique was performed in 10 patients with a mean anastomosis duration of 30 minutes （ range ： 25 - 45 ） and a mean operative duration of 220 minutes （range： 200 -300）. The Foley catheter was implanted for 14 days. Neither bladder neck stricture nor urinary leak was observed with a follow-up period of 3-24 months. Conclusions The described technique is a feasible and safe method for urethrovesical anastomosis with a low rate of complications. And it may be quickly mastered so as to lower the learning curve of a novice.

关 键 词：前列腺肿瘤 腹腔镜检查 膀胱尿道吻合 

分 类 号：R737.25[医药卫生—肿瘤]