钝头针无损伤缝合阴茎背深静脉复合体在腔镜前列腺癌根治术中的应用  

Application of blunt-tip needle to suture dorsal venous complex in laparoscopic radical prostatectomy

作　　者：张超[1] 王辉清[1] 过菲[1] 杨波[1] 孙颖浩[1] 

机构地区：[1]第二军医大学长海医院泌尿外科,上海200433

出　　处：《第二军医大学学报》2015年第4期439-442,共4页Academic Journal of Second Military Medical University

基　　金：第二军医大学长海医院学科重点发展基金~~

摘　　要：目的探讨钝头针无损伤缝合阴茎背深静脉复合体在腔镜前列腺癌根治术中的安全性和有效性。方法回顾2012年1月至2014年7月,我院同一位医生开展的腹腔镜前列腺癌根治术和机器人辅助腹腔镜前列腺癌根治术,临床资料对病例及手术录像进行回顾性研究,分析缝合阴茎背深静脉复合体时使用的缝针、进出针点的暴露情况、背深静脉出血及误扎导尿管的例数,分析术后前列腺尖部切缘阳性的例数,随访术后3个月患者尿控情况。结果共104例腔镜前列腺癌根治术患者纳入研究。56例患者采用常规缝针缝扎阴茎背深静脉复合体,其中52例患者可清晰分离出前列腺尖部和膜部尿道连接处的解剖标记"黄金眼";48例患者采用钝头针无损伤缝合,其中44例患者可分离"黄金眼"。采用钝头针进行无损伤缝合,缝扎及剪断尿道时患者出血量减少、尿控恢复较好(P<0.05)。结论在准确定位解剖标志"黄金眼"的前提下,采用钝头针缝合阴茎背深静脉复合体可完全阻断阴茎背深静脉复合体,减少患者出血量,保持分离尿道时良好术野,利于术后控尿恢复。Objective To evaluate the safety and efficacy of using blunt-tip needle to suture the dorsal venous complex（DVC）in laparoscopic radical prostatectomy.Methods The clinical data and the operation videos of patients,who received laparoscopic and robot-assisted radical prostatectomies by a single surgeon in our hospital from Jan.2012 to Jul.2014,were retrospectively reviewed.The needles used to suture DVC,exposure of suture points,bleeding of DVC,and cases of mistakenly sutured catheter and positive margins at the epic were analyzed.Continence of patients was followed and analyzed 3months after surgery.Results A total of 104 cases were enrolled in this study.DVC was sutured with traditional needles in 56 cases,and in52 of them the junction between prostate epic and membranous urethra（so called golden eye）could be exposed.DVC was sutured with blunt-tip needles in 48 cases,and the＂golden eye＂could be found in 44 of them.Suturing with blunt-tip needles,compared with traditional needles,resulted in significantly less bleeding and significantly better continence recovery（P〈0.05）.Conclusion Dorsal venous complex can be completely sutured by using blunt-tip needle once the ＂golden eye＂is correctly indentified,which can decease the intraoperative bleeding and maintain a clear surgical field,improving the postoperative continence recovery.

关 键 词：前列腺肿瘤 前列腺癌根治术 腹腔镜手术 机器人手术 背深静脉复合体 

分 类 号：R737.25[医药卫生—肿瘤]