3D腹腔镜下根治性膀胱前列腺切除术的初步经验  

Preliminary experience of laparoscopic radical cystectomy and prostatectomy with three-dimensional laparoscopy

作　　者：刘皓[1] 林天歆[1] 许可慰[1] 韩金利[1] 黄海[1] 董文[1] 毕良宽[1] 张彩霞[1] 朱定军[1] 姚友生[1] 谢文练[1] 黄健[1] 

机构地区：[1]中山大学孙逸仙纪念医院泌尿外科,广州510120

出　　处：《中华泌尿外科杂志》2013年第10期767-770,共4页Chinese Journal of Urology

摘　　要：目的总结利用3D腹腔镜行根治性膀胱、前列腺切除手术的初步经验。方法2012年10月至2013年6月收治的男性患者46例。年龄56～78岁，平均65岁。其中22例诊断为膀胱癌，术前分期T1期6例，T2期10例，T3期6例；24例诊断为前列腺癌，术前分期T1c期7例，T2a期5例，T2b期3例，T2c期2例，T3a期7例，术前tPSA6．5～33．5μg／L，中位tPSA14．5μg／L。所有患者术前排尿、控尿功能良好。22例膀胱癌患者行3D腹腔镜下根治性膀胱切除．原位回肠新膀胱术，24例前列腺癌患者行3D腹腔镜下根治性前列腺切除术。记录患者的手术时间、出血量、术后住院时间、并发症发生情况、随访情况等。结果46例手术均在3D腹腔镜系统下完成，无中转开放手术或普通腹腔镜手术。22例根治性膀胱切除-原位回肠新膀胱术手术时间210～350min，平均255min；出血量100～300ml，平均150ml；术后住院天数9～21d，平均15d；围手术期出现膀胱-尿道吻合口漏1例，肠梗阻l例，淋巴漏1例。24例根治性前列腺切除术手术时间90～200min，平均103min；出血量50～200ml，平均78ml；术后住院天数7～17d，平均13d；围手术期出现膀胱-尿道吻合口漏1例。随访1～8个月，膀胱癌患者术后1个月日间控尿率22．7％（5／22）、夜间控尿率4．5％（1／22）；术后3个月日间控尿率66．7％（10／15）、夜间控尿率40．0％（6／15）；术后6个月日间控尿率85．7％（6／7）、夜间控尿率57．1％（4／7）。前列腺癌患者术后1个月控尿率79．1％（19／24），术后3个月控尿率88．9％（16／18），术后6个月控尿率100．0％（8／8）。所有患者均未见肿瘤复发。术前6例患者勃起功能良好（IIEF-5≥16），3例术后6个月勃起功能恢复良好（IIEF-5≥16）。结论3D腹腔镜有良好的立体视野，能增加手术的精确性，在保证肿瘤治疗效果的同时可以更好地改善术后早�Objective To assess the preliminary experience of laparoscopie radical eystectomy and prostateetomy with three-dimensional （3D） laparoscopy. Methods From Oct. 2012 to Jun. 2013, 46 patients had accepted 3D laparoseopie radical eystectomy for bladder cancer （22 cases） and prostatectomy for prostate cancer （24 cases） in our hospital. The perioperative and follow-up data （operative time, estimated blood loss, complications, post-operative hospital stay, pathological data, oncologic outcome, continence and erectile function） were analyzed. Results All 46 operations were finished uneventfully, without con- version to open or conventional laparoscopic surgery. The mean operative time was 103 min for radical prostatectomies, 255 min for radical cystectomies with orthotopic ileal neobladder, the mean estimated biood loss was 82 ml for radical prostatectomies, 150 ml for radical cystectomies. Follow-up data showed excellent oncological results and satisfactory functional results. Continence rate after cystectomy is 66.7% at 3 months and 85.7% at 6 months postoperatively in daytime, 40.0% and 57.1% at night respectively. Continence rate after prostateetomy is 79.1% at 1 month, 88.9% at 3 months and 100.0% at 6 months postoperatively. Conclusions 3D laparoscopy provides high-quality 3D endoscopic view and facilitates precise manipulation during surgery, resulting in satisfactory oncologieal and functional outcomes for the pelvic surgeries.

关 键 词：3D腹腔镜 根治性膀胱切除术 根治性前列腺切除术 

分 类 号：R699[医药卫生—泌尿科学]