耻骨后前列腺癌根治术的技术改进(附32例报告)

Technical improvements in radical retropubic prostatectomy (report of 32 cases)

目的 改进耻骨后前列腺癌根治术的手术技术 ,减少并发症。 方法 临床诊断为T1和T2 期前列腺癌患者 32例 ,平均年龄 6 8岁。改进耻骨后前列腺癌根治技术 ,包括广泛盆腔淋巴结清扫、保护神经血管束、缝扎背深静脉、多保留尿道后壁组织、膀胱尿道吻合时的膀胱颈部套叠等。 结果 手术时间平均 3.5h ,术中平均出血量 4 5 0ml,输血 1 7例。术后病理报告 :肿瘤局限于包膜内者30例 ,切缘阳性 1例 ,盆腔淋巴结转移 1例。随访 8～ 4 8个月 ,平均 2 2个月 ,均存活。PSA <1ng/ml者2 8例 ,1～ 3ng/ml者 4例。术后 3～ 6个月患者均恢复完全控尿。术后恢复勃起功能者 1 0 / 1 8(5 6 % )例。 结论 耻骨后前列腺癌根治术可有效切除肿瘤、保护控尿功能、保留性功能 ,是局限性前列腺癌的首选治疗方法。

Objective To evaluate the effect of technical improvement of radical retropubic prostatectomy (RRP) for patients with localized prostatic cancer. Methods RRP was performed in 32 cases (mean age,68 years) of prostatic cancer at clinical T 1 and T 2 stages.Technical improvements included extensive lymph node clearance,protection of the neurovascular bundle,suture and ligation of the dorsal vein complex,preservation of the distal prostatic urethra,and intussusception of the bladder neck. Results The mean operative time was 3.5 h.The mean blood loss was 450 ml;blood transfusion was conducted in 17 cases.Postoperative pathologic findings revealed tumor confined disease in 30 cases,positive surgical margin in 1, and lymph node metastasis in 1.All the patients survived and were followed up for a mean of 22 months (range 8 to 48 months),with PSA<1 ng/ml in 28 cases and 1 to 3ng/ml in 4.All the cases gained normal voiding within 6 months postoperatively.Sexual function recovered in 10/18 (56%)cases. Conclusions RRP is effective in tumor controlling,continence preserving and sexual function retaining in patients with organ confined prostatic cancer.