经腹膜外途径腹腔镜下前列腺癌根治术29例报告  

Extraperitoneal laparoscopic radical prostatectomy:report of 29 cases

作　　者：蒋晓东[1] 周忠兴[1] 刘伟民[1] 李寿春[1] 白禹[1] 陈加生[1] 

机构地区：[1]常州市第二人民医院阳湖院区泌尿外科,江苏常州213000

出　　处：《临床泌尿外科杂志》2014年第12期1057-1060,共4页Journal of Clinical Urology

摘　　要：目的：探讨经腹膜外途径腹腔镜下前列腺癌根治术（ELRP）的手术方法和临床效果。方法：对2011年6月~2014年2月行ELRP术29例患者的临床资料进行回顾性分析：患者年龄60~77岁,平均68岁。所有患者均于术前行前列腺穿刺活组织检查或前列腺电切术后经病理检查证实为前列腺癌,术前总PSA平均18.9μg/L,其中〈4.0μg/L者2例,4~20μg/L者16例,〉20μg/L者11例。均行ELRP。结果：手术时间60~330min,平均125min;术中出血量80~1 200ml,平均150ml;术中输血2例。1例因阴茎背静脉复合体出血中转开放手术。术中直肠损伤1例。术后病理检查均证实为前列腺癌,Gleason评分6~9分,切缘阳性3例。术后留置导尿管时间12~26d,平均15d。拔除尿管后出现轻度尿失禁8例,术后1~3个月均可满意控尿。术后3个月检查血清PSA为0~0.18μg/L,未发现肿瘤局部生化复发和远处转移。结论：ELRP创伤小,并发症少,患者恢复快,是治疗局限性前列腺癌安全有效的手术方法。Objective：To evaluate the surgery skill and effects of extraperitoneal laparoscopic radical prostatectomy（ELRP）for prostate cancer.Method：From June 2011 to February 2014,ELRP was performed on 29 men,mean aged 68（range,60-77）years.All patients were diagnosed as prostate cancer by pathology preoperatively.The mean preoperative PSA was 18.9μg/L including two cases〈4.0μg/L,16 cases 4-20μg/L and 11cases〉20μg/L.Result：The mean operation duration was 125（range,60-330）min,and mean intraoperative blood loss was 150（range,80-1 200）ml.Two cases accepted blood transfusion during the operation.One patient was converted to open surgery owing to hemorrhage at the dorsal vein complex of penis and one was complicated by rectal injury.The pathologic exam demonstrated all the prostate cancer,and Gleason score was from six to nine.Postoperative pathological examination showed positive surgical margins in three cases.After the operation,urinary catheter was withdrawn in 12 to 26days（mean,15days）.Eight cases suffered from mild uroclepsia and returned to normal after one to three months.During the postoperative period of three months,no local recurrence or distant metastasis were found,and the postoperative PSA level was 0-0.18μg/L.Conclusion：ELRP may be considered as a feasible and safe surgical approach for localized prostate cancer,with minimal invasion,few complications and rapid recovery.

关 键 词：前列腺癌 前列腺癌根治术 腹腔镜术 腹膜外途径 

分 类 号：R737.25[医药卫生—肿瘤]