经会阴前列腺穿刺确诊即行腹腔镜前列腺癌根治术的分析  

作　　者：何华东[1] 袁翀[2] 丁志军[2] 水冰[1] 王于勇[1] 于志坚[1] 

机构地区：[1]杭州市第一人民医院泌尿外科,310006 [2]南京医科大学,210029

出　　处：《浙江临床医学》2016年第6期1005-1007,共3页Zhejiang Clinical Medical Journal

摘　　要：目的探讨B超引导下经会阴途径前列腺穿刺活检确诊前列腺癌后即刻行腹膜外途径腹腔镜下前列腺癌根治术的可行性及安全性。方法自2009年1月至2015年5月，对45例B超引导下经会阴途径前列腺穿刺活检确诊前列腺癌后即刻行腹膜外途径腹腔镜下前列腺癌根治术，前列腺特异抗原（PSA）2．5-39．8ng／ml，平均（13．2±4．3）ng／ml，格里森（Gleason）评分5-9分；同期对25例同法穿刺确诊的前列腺癌患者等待6-8周后再行根治手术，其PSA4．3-40．1ng／ml，平均（11．5±3．8）ng／ml，Gleason评分6-8分。比较两组前列腺与直肠粘连程度、出血量、手术时间、切缘阳性率等。结果前列腺与直肠粘连较为明显即刻手术组3例（3／45），延迟手术组2例（2／25）。术中出血量即刻手术组100-900ml，平均（260±63）ml；延迟手术组140-800ml，平均（290±55）ml。手术时间即刻手术组125-360min，平均（155±28）min；延迟手术组110-300min，平均（160±32）min；切缘阳性即刻手术组4例，延迟手术组3例。两组手术组在前列腺与直肠粘连程度、出血量、手术时间、切缘阳性率等方面差异均无统计学意义（P〉0．05）。结论B超引导下经会阴途径前列腺穿刺活检对前列腺及周围组织的出血、炎症粘连等影响较小，确诊后即刻行腹膜外途径腹腔镜下前列腺癌根治术是可行和安全的。Objective To investigate the feasibility and safety of immediate extraperitoneal laparoscopic radical prostatectomy after diagnosis of prostate cancer with saturated perineal prostate biopsy by using B ultrasound guidance. Methods From January 2009 to May 2015 we had 70 cases of extraperitoneal laparoscopic radical prostatectomy after diagnosis of prostate cancer with saturated perineal prostate biopsy by using B ultrasound guidance, including 45 cases which received immediate operation with prostate specific antigen （ PSA ） level of 13.2 ± 4.3 （ 2.5-39.8 ） ng/ml, Gleason score 5-9 and 25 cases which received operation 6-8 weeks after biopsy with PSA level of 11.5± 3.8 （ 4.3-40.1 ） ng/ml, Gleason score 6-8. We compared the extent of the adhesion between prostate and rectum, the amount of blood loss, operation time and surgical margin positive rate, etc between those two groups. Results 3 cases had apparent adhesion between prostate and rectum in the group of immediate operation （ 3/45 ） , 2 cases in the group of delayed operation （ 2/25 ） ; the blood losses in those two gruops were260 ± 63ml （ 100-900ml ） in the immediate operation group, 290 ± 55ml （ 140-800ml ） in the delayed operation group; the operation time in those two gruops were 155 ± 28 min （ 125-360 min ） in the immediate operation group, 160± 32 min （ 110-300 min ） in the delayed operation group.No statistical significance existed in the adhesion extent, blood loss, the operation time, positive margin rate, etc between those two groups. （P〉0.05） . Conclusion Saturated perineal prostate biopsy by using B ultrasound guidance has no influence on prostatic bleeding and surrouding tissue adhesion. Immediate extraperitoneal laparoscopic radical prostatectomy after saturated perineal prostate biopsy by using B ultrasound guidance won＇t increase surgical difficulty and complication, it＇s a safe and feasible biopsy procedure.

关 键 词：前列腺癌 前列腺癌根治术 前列腺穿刺 

分 类 号：R737.14[医药卫生—肿瘤]