改良经腹腔途径腹腔镜下前列腺癌根治术285例临床研究  

Modified transperitoneal laparoscopic radical prostatectomy： clinical study of 285 cases

作　　者：李普[1] 殷长军[1] 邵鹏飞[1] 秦超[1] 孟小鑫[1] 居小兵[1] 李杰[1] 吕强[1] 华立新[1] 王增军[1] 顾民[1] 徐正铨[1] 

机构地区：[1]南京医科大学第一附属医院泌尿外科,210029

出　　处：《中华泌尿外科杂志》2012年第10期749-752,共4页Chinese Journal of Urology

摘　　要：目的评价改良经腹腔途径腹腔镜下前列腺癌根治术的手术技术及其临床效果。方法回顾性分析2008年1月至2012年4月收治的285例前列腺癌患者的临床资料。年龄50～76岁，平均67岁。保留性神经组年龄51～69岁，平均60岁。术前PSA1．8～50．0μg／L，平均15．7μg／L。B超检查测量前列腺体积为26～74ml，平均44ml。术前盆腔CT或MRI检查，均未见明显肿大淋巴结和精囊、盆壁侵犯；核素骨扫描检查未见骨转移。271例术前行经直肠前列腺穿刺活检病理检查确诊，14例TURP后病理检查发现。Gleason评分6～8分，其中6分74例、7分192例、8分19例。肿瘤临床分期T1b期14例，T1a期29例，T2期214例，T3a期28例。全麻下行腹腔镜下前列腺癌根治术，采取经腹腔径路，术中对膀胱颈分离、性神经的保留以及膀胱颈后尿道吻合等技术进行了改良。结果本组手术时间55～210min，平均105min；术中出血50～800ml，平均240ml；均未中转开放手术；术中发生直肠损伤2例，均在腔镜下缝合修补。术后无肠道并发症。术后48～72h拔除引流管，5～8d拔除尿管，术后住院时间为5～11d，平均7d。术后病理检查切缘阳性58例。术后随访时间3～50个月，平均29个月。208例拔尿管后恢复正常排尿，77例出现不同程度尿失禁，其中68例在术后3个月内恢复控尿，9例3个月后仍有压力性尿失禁表现。保留性神经的57例患者中42例术后恢复勃起功能。结论经腹腔途径腹腔镜下前列腺癌根治术是一种安全有效的手术方法，术中对膀胱颈分离、性神经保留及后尿道吻合等技术的改进可明显提高手术效率，减少手术并发症，改善患者生活质量。Objective To evaluate the technique and clinical outcomes of modified transperitoneal laparoseopie radical prostateetomy. Methods A total of 285 patients received the operation with mean age of 67 years （50 -76 years） from January 2008 to April 2012. Mean level of PSA was 15.7 μg/L （ 1.8 - 50.0 μg/L） , and mean prostatic volume was 44 ml （26 -74 ml）. No lymph node or seminal vesicle in- volvement was found by CT or MR and radionuelide bone scan revealed no metastasis. 271 cases were con- firmed diagnosis by prostatic biopsy and 14 were detected through pathological studies of TURP speeimens. Gleason score ranged from 6 to 8.14 cases were in clinical stage Tlb, 29 cases in Tic, 214 eases in T2 and 28 eases in T3. Transperitoneal approach and modified technique involving bladder neck disseetion, nerve- sparing technique and vesicoureteral anastomosis were applied on patients. Results Mean operative time was 105 rain （55 -150 rain）. Mean intraoperative estimated blood loss was 240 ml （50 -800 ml）. Rectal injures occurred in 2 eases and were repaired under laparoseopy. Drainage tube and urinary catheter were re-moved 48 - 72 h and 5 - 8 d postoperatively. Postoperative hospital stay was 7 d （5 - 11 d）, Positive surgi- cal margin was present in 58 patients. Mean follow-up time was 29 months （3 -50 months）, Complete con- tinence were found in 208 patients immediately after catheter removal. 68 patient recovered continence within 3 months and 9 patients remained incontinence 3 months after surgery. Normal erection presented in 4-2 of the 57 cases with nerve-sparing. Conclusions Transperitoneal laparoscopic radical prostatectomy is safe and efficient. Higher efficiency and lower complication rate have been achieved through modified laparoscop- ie technique involving bladder neck dissection, nerve-sparing technique and vcsicoureteral anastomosis.

关 键 词：前列腺肿瘤 腹腔镜 经腹腔途径 前列腺癌根治术 

分 类 号：R737.25[医药卫生—肿瘤]