头侧站位三孔法经腹膜外途径腹腔镜根治性前列腺切除术的临床应用与初步体会  

Study on the clinical application and preliminary experience of cephalic position three-port extraperitoneal laparoscopic radical prostatectomy

作　　者：李永炜 孙伍柒 雷永刚 付德来[1] 李和程[1] 种铁[1] 李钊伦[1] LI Yongwei;SUN Wuqi;LEI Yonggang;FU Delai;LI Hecheng;CHONG Tie;LI Zhaolun(Department of Urology,the Second Affiliated Hospital of Xi'an Jiaotong University,Shaanxi Xi'an 710004,China;Department of Urology,Weinan Central Hospital,Shaanxi Weinan 714000,China)

机构地区：[1]西安交通大学第二附属医院泌尿外科,陕西西安710004 [2]渭南中心医院泌尿外科,陕西渭南714000

出　　处：《现代肿瘤医学》2022年第19期3547-3551,共5页Journal of Modern Oncology

基　　金：陕西省自然科学基础研究计划一般项目(面上项目)(编号:2018JM7051)。

摘　　要：目的:探讨头侧站位三孔法经腹膜外途径腹腔镜根治性前列腺切除术的临床应用价值与体会。方法:收集于2012年01月至2019年12月行根治性前列腺切除术的111例患者资料,其中56例患者采用常规体侧站位(四孔或五孔)经腹膜外途径腹腔镜根治性前列腺切除术(A组:体侧站位组),55例患者采用头侧站位三孔法经腹膜外途径腹腔镜根治性前列腺切除术(B组:头侧站位组),比较两组病例围手术期指标和术者疲劳度差异。结果:两组患者手术时间、术中出血量、术中输血率、引流管留置时间、生化复发、尿失禁、切缘阳性率和术后PSA方面无统计学差异(P>0.05),头侧站位组患者术后住院时间更短。两组术者肩部、双上臂、胸部、双下肢疲劳度和1小时内眨眼频率无统计学差异(P>0.05),头侧站位组术者颈部、腰背部疲劳度更低且超过1小时后术者的眨眼频率更少(P<0.05)。结论:头侧站位三孔法经腹膜外途径腹腔镜根治性前列腺切除术并未明显增加手术难度,该术式优点在于患者术后恢复更快。头侧站位组术者、术野和显示屏三点位于一线,可以明显缓解术者及助手发生肌肉疲劳。Objective:To investigate the clinical application value and experience of the cephalic position three-port extraperitoneal laparoscopic radical prostatectomy.Methods:Data of 111 patients who underwent radical prostatectomy from January 2012 to December 2019 were collected,among which 56 patients underwent conventional lateral position(four or five ports)extraperitoneal laparoscopic radical prostatectomy(lateral position group,group A)and 55 patients underwent laparoscopic radical prostatectomy using the cephalic position three-port extraperitoneal approach(cephalic position group,group B).The difference in surgical efficacy for patients and fatigue degree of surgeon between the two groups were compared.Results:There were no significant differences in operative time,blood loss,transfusion rate,indwelling time of drainage tube,biochemical recurrence,uroclepsia rate,positive rate of surgical margin and PSA between the two groups(P>0.05).The postoperative hospital stay of patients in the cephalic position group was shorter.There was no significant difference in fatigue of shoulder,upper arms,chest and lower limbs and blink frequency within 1 hour between the two groups(P>0.05).Patients in the cephalic position group had lower neck and back fatigue,and less blink frequency after 1 hour(P<0.05).Conclusion:Laparoscopic radical prostatectomy using the cephalic position three-port extraperitoneal approach did not significantly increase the difficulty of the operation.The advantage of this procedure is that patients recover more quickly after operation.In the cephalic position group,the operator,the operating field and the display screen are located in the same straight line,which could significantly relieve the muscle fatigue of the operator and assistant.

关 键 词：腹腔镜 根治性前列腺切除术 腹膜外途径 头侧站位 疲劳度 

分 类 号：R737.25[医药卫生—肿瘤]