腹膜外入路经脐单孔腹腔镜下前列腺癌根治术11例报告  

Extraperitoneal transumbilicai single-port laparoscopic radical prostatectomy： A report of 11 cases

作　　者：林天歆[1] 黄健[1] 江春[1] 许可慰[1] 叶枫[2] 黄海[1] 韩金利[1] 姚友生[1] 谢文练[1] 张彩霞[1] 董文[1] 刘皓[1] 

机构地区：[1]中山大学孙逸仙纪念医院泌尿外科,广州510120 [2]中山大学孙逸仙纪念医院体检中心,广州510120

出　　处：《中华泌尿外科杂志》2011年第2期94-98,共5页Chinese Journal of Urology

基　　金：基金项目：国家重大项目卫生行业公益性事业专项（200802015）,教育部博士点基金（No：20060558027）,广州市科技局重点项目（No：200522-E0121）,中山大学5010项目（2007018）和卫生部临床重点项目资助（2007黄健）

摘　　要：目的探讨使用自制多通道套管经脐切口行单孔腹腔镜下前列腺根治性切除术的方法及初步疗效。方法2009年8月至2010年3月，对11例局限性前列腺癌患者行单孔腹腔镜下前列腺根治性切除术。经脐3cm切口，腹膜前置入自制多通道套管，行单孔腹腔镜下双侧闭孔淋巴结清扫、前列腺根治性切除、膀胱尿道吻合术。膀胱尿道吻合采用活结套结连续缝合法完成。结果1例增加1个套管，其余10例手术均顺利完成，无中转常规腹腔镜手术或开放手术。平均手术时间256（195～315）min，平均出血量90（20～180）ml，平均术后住院时间15．4（13～24）d，术后12d拔除尿管。无术中并发症。术后1例出现膀胱尿道吻合口漏、2例出现淋巴漏、1例出现泌尿系感染，均经保守治疗治愈。病理报告11例手术标本切缘均阴性，清扫淋巴结阴性。患者平均随访7（3～11）个月，无肿瘤生化复发。结论单孔腹腔镜下前列腺根治性切除术技术上可行，具有美观、微创、并发症少的特点，具有良好的短期功能和肿瘤控制效果，中长期疗效需进一步随诊观察。Objective To present our initial experience in laparoscopic radical prostatectomy performed through an umbilical incision using a homemade multichannel port. Methods From August 2009 to March 2010, we performed single-port laparoscopic radical prostatectomy in 11 patients with localized prostate cancer. A home-made multichannel port was inserted extraperitoneally through a 3-cm umbilical incision. The single port extraperitoneal procedures included obturator fossa lymphadenectomy, radical prostatectomy and urethro-vesical anastomosis, while the urethro-vesical anastomosis was performed by a slip-knot running suture technique. Data were collected and analyzed prospectively. Results All cases were completed successfully, without conversion to a standard laparo- scopic approach or open surgery except adding an additional port in one case. The average operative time was 256 minutes （range195--315）, and the mean blood loss was 90 ml （range 20--180）, without any blood transfusion. The postoperative hospital stay was 15.4 days （range13--24）, and the Foley catheter was removed 12 days after surgery. No intraoperative complications occurred. One patient developed a vesico-rethralanastomosis leakage, 2 had lymphatic leakage and 1 had urinary tract infection, all of the cases were managed successfully with conservative treatment. Histopathological results showed negative surgical margine and negative lymph node dissection. All patients had no biochemical relapse after an average follow up of 7 months. Conclusions Single-port laparoscopic radical prostatectomy is feasible, cosmetic and minimally invasive with a low complication rate and good short-term outcome. Additional investigation is needed to evaluate the long-term safety and oncologic adequacy of this new approach.

关 键 词：前列腺肿瘤 前列腺根治性切除术 腹腔镜 单孔腹腔镜-内镜手术 

分 类 号：R737.25[医药卫生—肿瘤]