腹腔镜根治性膀胱前列腺切除术治疗前列腺癌广泛侵及膀胱6例报告  

Laparoscopic Radical Cystoprostatectomy for Prostate Cancer With Extensive Invasion of Bladder:Report of 6 Cases

作　　者：杨旭[1] 周凯[1] 李梦强[1] 李永生[1] Yang Xu;Zhou Kai;Li Mengqiang(Department of Urology,Fujian Medical University Union Hospital,Fuzhou 350001,China)

机构地区：[1]福建医科大学附属协和医院泌尿外科,福州350001

出　　处：《中国微创外科杂志》2022年第8期662-666,共5页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的 探讨腹腔镜根治性膀胱前列腺切除术治疗前列腺癌广泛侵犯膀胱的疗效。方法 2015年12月~2019年6月我们对6例前列腺癌广泛侵及膀胱行腹腔镜下根治性膀胱前列腺切除及尿流改道手术,采用经腹腔入路五孔法,游离输尿管中下段至膀胱壁外,由髂总动脉分叉处开始,清扫两侧髂外动脉旁淋巴结、闭孔淋巴结和髂内动脉旁淋巴结,游离输精管、精囊及前列腺后面,游离膀胱前壁,缝扎阴茎背深静脉复合体,游离膀胱侧韧带及前列腺侧韧带,离断尿道,在腹腔镜下完成膀胱前列腺切除和淋巴结清扫,后距回盲处近端约20 cm处取长约15 cm回肠,体外构建流出道。术后均行辅助内分泌治疗。结果 6例腹腔镜下根治性膀胱前列腺切除联合回肠膀胱通道术顺利完成,无中转开放手术及输血。手术时间(322.5±41.2)min,术后住院时间(10.8±2.5)d,无Ⅲ级及以上并发症。术后切缘阳性4例,淋巴结阳性4例;术后病理分期T4N1M0期4例,T4N0M0期2例。术后局部症状改善明显,局部症状评分平均0.5分(0~1分),低于术前(平均3.2分)。术后1个月血肌酐(109.8±23.7)mmol/L。6例中位随访45(30~72)个月,1例死于心脏疾病,2例PSA进展,辅助放疗及多西他赛治疗,3例未见复发或转移。结论 腹腔镜根治性膀胱前列腺切除术可作为前列腺癌广泛累及膀胱的一种治疗选择,能改善患者局部症状。Objective To evaluate the efficacy of laparoscopic radical cystoprostatectomy in the treatment of prostate cancer with extensive bladder invasion.Methods Clinical data of 6 patients with prostate cancer with extensive bladder invasion who were treated with laparoscopic radical cystoprostatectomy and urinary diversion in our hospital from December 2015 to June 2019 were retrospectively analyzed.The operation was performed by 5-hole transperitoneal approach to free the middle and lower ureters outside the bladder wall.Starting from the bifurcation of the common iliac artery,we cleaned the lymph nodes near the external iliac artery,obturator lymph nodes and paraarterial lymph nodes of internal iliac artery on both sides,dissected the vas deferens,seminal vesicles,back of the prostate,and anterior wall of the bladder.The deep dorsal vein complex of the penis was sutured,and the lateral bladder ligament and the lateral prostate ligament were freed.The urethra was severed.Cystoprostatectomy and lymph node dissection were completed under laparoscopy,and the ileum was taken about 15 cm long from the place about 20 cm away from the proximal ileocecal part.The outflow tract was constructed in vitro.All the patients were treated with androgen deprivation therapy.Results All the 6 patients underwent laparoscopic radical cystoprostatectomy and ileal conduit.The operations were successfully completed without conversion to open surgery or blood transfusion.The operation time was(322.5±41.2)min,the postoperative hospital stay was (10. 8 ± 2. 5) d, and there were no grade Ⅲ or above complications. There were 4 cases of positive postoperative resection margin and 4 cases of positive lymph node. The postoperative pathological staging showed T4N1M0 in 4 cases and T4N0M0 in 2 cases. The local symptoms improved significantly after operation. The mean local symptom score was 0. 5 points (range, 0 - 1 points), which was lower than preoperation (mean, 3. 2 points). The creatinine level was (109. 8 ± 23. 7) mmol/ L at 1 month after o

关 键 词：前列腺癌 膀胱前列腺切除术 腹腔镜 

分 类 号：R737.25[医药卫生—肿瘤]