腹膜瓣间置技术在腹腔镜根治性前列腺切除术+扩大盆腔淋巴结清扫中预防盆腔淋巴囊肿的疗效  

Application of peritoneal interposition flap technique in the prevention of pelvic lymphocysts after laparoscopic radical prostatectomy with extended pelvic lymph node dissection

作　　者：黄立群 王学雷 杨国胜 李容炳 李冬阳 叶静 黄炜韬 王杭 郭剑明 温晓飞 Huang Liqun;Wang Xuelei;Yang Guosheng;Li Rongbing;Li Dongyang;Ye Jing;Huang Weitao;Wang Hang;Guo Jianming;Wen Xiaofei(Department of Urology,Shanghai East Hospital,Tongji University School of Medicine,Shanghai 200120,China;Department of Urology,Shanghai Geriatrics Center,Shanghai 200237,China;Department of Urology,Zhongshan Hospital Fudan University,Shanghai 200032,China)

机构地区：[1]上海市东方医院(同济大学附属东方医院)泌尿外科,上海200120 [2]上海市老年医学中心泌尿外科,上海200237 [3]复旦大学附属中山医院泌尿外科,上海200032

出　　处：《中华泌尿外科杂志》2024年第8期608-613,共6页Chinese Journal of Urology

基　　金：浦东新区卫生系统优秀青年医学人才培养计划(PWRq2020-43);浦东新区卫生健康委员会前列腺癌特色专病(PWZzb2022-04)。

摘　　要：目的探讨经腹腔途径腹腔镜根治性前列腺切除术(LRP)+扩大盆腔淋巴结清扫(ePLND)术中应用腹膜瓣间置技术(PIF)预防术后盆腔淋巴囊肿的疗效。方法回顾性分析2020年1月至2023年11月上海市东方医院收治的113例局部高危或局部进展期前列腺癌患者的临床资料。所有患者均接受LRP+ePLND,其中27例应用PIF技术(PIF组),86例行传统LRP+ePLND(对照组)。PIF组和对照组的年龄[(68.37±6.92)岁与(70.47±5.72)岁],体质量指数[(25.47±2.49)kg/m^(2)与(24.46±2.80)kg/m^(2)],术前前列腺特异性抗原[(23.28±13.94)ng/ml与(24.81±13.99)ng/ml]比较差异均无统计学意义(P>0.05)。PIF组穿刺Gleason评分6分2例,7分14例,8分9例,9~10分2例;临床分期T_(2)期18例,T_(3)期6例,T_(4)期3例。对照组穿刺Gleason评分6分4例,7分35例,8分27例,9~10分20例;临床分期T_(2)期51例,T_(3)期27例,T_(4)期8例。PIF组与对照组的术前Gleason评分和临床分期比较差异均无统计学意义(P>0.05)。ePLND清扫范围包括外动静脉、髂内动脉内侧、闭孔旁淋巴结。PIF技术是将游离膀胱后形成的腹膜瓣缝合至膀胱侧外方,使随膀胱游离的腹膜边缘拉进耻骨后,卷向膀胱侧外方表面,可暴露出淋巴结清扫床,建立了淋巴结清扫床至腹腔空间的通道,使渗出的淋巴液可流至腹腔被腹膜吸收。比较两组的手术时间、术中出血量、淋巴结阳性率、术后淋巴囊肿发生率、术后尿控恢复情况等。结果所有手术均顺利完成,术中未发生严重并发症。PIF组和对照组的手术时间[(202.96±24.15)min与(201.1±29.85)min]、术中出血量[(85.56±32.27)ml与(90.7±49.25)ml]、术后淋巴结阳性例数[4例(14.8%)与25例(29.1%)]比较差异均无统计学意义(P>0.05)。术后留置导尿管时间10~14d。PIF组与对照组术后1个月尿控率[51.85%(14/27)与48.83%(42/86)]、术后2个月尿控率[74.07%(20/27)与72.09%(62/86)]比较差异均无统计学意义(P>0.05)。术后2~6个月门诊复�Objective To investigate the efficacy of Peritoneal interposition flap(PIF)technique in preventing postoperative pelvic lymphocele formation during laparoscopic radical prostatectomy with extended pelvic lymph node dissection(LRP+ePLND).Methods A retrospective analysis was conducted on clinical data of 113 patients with locally high-risk or locally advanced prostate cancer who underwent LRP+ePLND at Shanghai East Hospital,from January 2020 to November 2023.Among them,27 patients received PIF technique and 86 received traditional LRP+ePLND.ePLND was carried out as the clearance of external iliac vessels,medial side of the internal iliac artery,and pararectal lymph nodes.The PIF technique was the suturing the peritoneal flap after freeing the bladder to the lateral side of the bladder,pulling the peritoneal edge that follows the bladder's free edge posteriorly to the pubis,curling it onto the lateral surface of the bladder.This could expose the lymph node clearance bed,establishing a pathway from the lymph node clearance bed to the abdominal cavity space,allowing exuded lymphatic fluid to flow into the abdominal cavity for absorption by the peritoneum.There were no statistically significant differences in age[(68.37±6.92)years vs.(70.47±5.72)years],body mass index[(25.47±2.49)kg/m^(2) vs.(24.46±2.80)kg/m^(2)],and preoperative PSA[(23.28±13.94)ng/ml vs.(24.81±13.99)ng/ml]between the PIF group and the control group(P>0.05).Biopsy Cleason score in PIF group:6 in 2 cases,7 in 9 cases,8 in 9 cases,9-10 in 2 cases.Biopsy Gleason score in control group:6 in 4 cases,7 in 35 cases,8 in 27 cases,9-10 in 20 cases.Clinic stage in PIF group:T_(2) in 18 cases,T_(3) in 6 cases,T_(4) in 3 cases.Clinic stage in control group:T_(2) in 5lcases,T_(3) in 27 cases,T_(4) in 8 cases.The preoperative Gleason scores and TNM staging comparisons between the PIF group and the control group showed no statistically significant differences(P>0.05).Surgical duration,intraoperative blood loss,lymph node positivity rate,incidence of postoperat

关 键 词：前列腺肿瘤 癌 扩大盆腔淋巴结清扫 腹膜瓣间置 淋巴囊肿 预防 

分 类 号：R737.25[医药卫生—肿瘤]