免结扎血管筋膜复合体技术在腹腔镜根治性前列腺切除术中的应用(附32例报告)  

Technique of dorsal vascular complex-ligation free in laparoscopic radical prostatectomy: a report of 32 cases

作　　者：陈玢屾[1] 徐亚文[1] 徐啊白[1] 刘春晓[1] 郑少波[1] 李虎林[1] 许凯[1] 

机构地区：[1]南方医科大学珠江医院泌尿外科,广东广州510282

出　　处：《中国内镜杂志》2013年第1期46-49,共4页China Journal of Endoscopy

摘　　要：目的介绍免结扎血管筋膜复合体技术在腹腔镜根治性前列腺切除术中的应用。方法 2009年12月～2011年9月32例前列腺癌患者接受腹腔镜根治性前列腺切除术。术中采用免结扎(ligationfree)技术处理血管筋膜复合体(DVC),记录术中出血量和手术时间,观察术后出血量、术后导尿管留置时间、前列腺尖部切缘阳性率。术后进行随访。结果所有患者采用免缝扎技术处理DVC均获得满意的止血效果。此步骤手术时间为10～25min,平均13.1min,此步骤手术出血量为10～100mL。所有病例前列腺尖部切缘阴性。术后2～3周拔除尿管,17例患者拔除尿管后1周内排尿即完全可控,所有患者无永久性尿失禁发生。术后随访未发现肿瘤复发和远处转移。结论 DVC的完整对于尿控起到重要的作用,DVC免结扎技术能够清晰暴露前列腺尖部,保留尽可能长的功能尿道,有助于腹腔镜根治性前列腺切除术术后尿控的恢复,可以减少手术时间,并不明显增加术中出血量。【Objective】To introduce the surgical steps of dorsal vascular complex （DVC）-ligation free in laparoscopic radical prostatectomy and present the preliminary results of our technique.【Methods】From December 2009 to September 2011, thirty-two DVC-ligation free laparoscopic radical prostatectomy procedures were performed in patients with clinically localized prostate cancer. The amount of bleeding and surgical time was recorded. The rates and location of positive surgical margins （PSM） as well as functional outcomes were presented. 【Results】All patients had satisfying results of bleeding control. The mean time of this step was 13.1 min （10~25 min） and blood loss was 10 ~100 mL. No case had PSM. After catheter removal, 17 patients resumed the ability of urinary control （0 pads） within 1 week. No patients had permanent urinary incontinence. Patients were followed up 3 to 24 months, no tumor recurrence and distant metastasis.【Conclusion】The integrity of DVC plays an important role in urinary control. By using DVC ligation-free technique, we can clearly expose the prostate apex and preserve the nearby anatomy that may enhance the functional outcome. Operation time can be saved and blood loss would not be significantly increased.

关 键 词：免结扎 尿控 血管筋膜复合体 腹腔镜 根治性前列腺切除 

分 类 号：R737.25[医药卫生—肿瘤]