腹腔镜前列腺癌根治术治疗高危前列腺癌的临床体会  

Experience of laparoscopic radical prostatectomy for high risk protate cancer

作　　者：陈昊[1] 诸禹平[1] 肖峻[1] 宣强[1] 项平[1] 亓林[1] 

机构地区：[1]合肥安徽省立医院泌尿外科,安徽230001

出　　处：《国际泌尿系统杂志》2015年第4期497-500,共4页International Journal of Urology and Nephrology

摘　　要：目的探讨腹腔镜前列腺癌根治术在高危前列腺癌治疗中的价值。方法回顾性分析2012年3月-2014年11月本院腹腔镜前列腺癌根治术治疗26例高危前列腺癌的临床资料。患者平均年龄65．2岁，术前检查单独PSA≥20ng／mL者9例；兼具PSA≥20ng／mL并Gleason评分≥8分者17例；术前诊断T3b和T4期各1例。3例患者因前列腺体积过大术前分别行3～6个月新辅助内分泌治疗。手术方式均采用经腹膜外路径腹腔镜前列腺癌根治术，同时行盆腔淋巴结清扫。结果26例手术均获成功，平均手术时间152min，平均出血量85mL，无输血病例。所有患者均于术后两周拔除导尿管，8例拔管后尿失禁，经盆底训练后于1周至3个月恢复控尿。术后病理T2a～T2b，Gleason评分≤7分者10例；T2c～T4，Gleason评分≥8分者16例。术中清扫淋巴结数目平均5．5个，淋巴结阳性3例；切缘阳性4例，术后控尿恢复后予局部放射治疗。19例获访3～30个月，所有患者均控尿良好，PSAG0．2ng／mL。结论对高危前列腺癌患者采用以根治性前列腺癌切除术为核心的综合治疗策略安全有效，可使患者获益。Objectives To evaluate the clinical efficiency of laparoscopic radical prostatectomy for high risk prostate cancer. Methods The clinical data of 26 patients with high risk prostate cancer who underwent laparoscopic radical prostatectomy from March 3, 2014 to November 2015 were analyzed retrospectively, with the average age of 65. 2 . In preoperative examination, there were 9 cases with PSA≥20ng/ml only, and 17 cases with PSA≥20ng/ml and Gleason score≥8 ,meanwhile there is one case in both the 33b phase and T4 phase. Three cases were treated with neo- adjuvant hormone therapy for 3 - 6 months. All patients underwent extraperitoneal laparoscopic radical prostatectomy and pelvic lymph node dissection. Results All operation were successful. The mean operation time was 152rain, mean blood loss was 85ml, mean catheterization time were two weeks. Postoperative temporary urinary incontinence occurred in 8 cases, and all recoved within 1 week to 3 months. After the operation, there were 7 cases in T2a - T2b phase and Gleason score≤7, 16 cases in T2c -T4 phase and Gleason score≥8. The mean number of lymph node dis- sected was 5.5. Three cases had lymph positive , four cases hadpositive surgical margins and all underwent radiation therapy after continence was regained. 19 cases were followed up for 3 -30 months, no true incontinence was observed, and PSA ≤0.2ng/ml in all patients. Conclusions As the core of comprehensive treatment strategies, radical prostatectomy is safe and effective for high risk prostate cancer.

关 键 词：前列腺肿瘤 腹腔镜检查 

分 类 号：R737.25[医药卫生—肿瘤]