经腹膜外腹腔镜前列腺癌根治术(附53例报告)

Extraperitoneal laparoscopic radical prostatectomy: report of 53 cases

目的研究分析腹膜外腹腔镜前列腺癌根治术的手术方法和疗效。方法我院自2003年2月至2006年12月对53例前列腺癌患者行腹膜外腹腔镜前列腺癌根治术，术前均由病理检查确诊，Gleason评分≤7分，盆腔CT、MR和ECT示无瓮腔淋巴结、精囊和骨转移．手术经腹膜外顺行径路切除前列腺，标本自脐下切口处取出。12例术中行盆腔淋巴结活检．5例行保留性神经前列腺癌根治。结果手术平均时间190min（110～270min），出血120～1200ml，平均320ml，术中直肠损伤2例，4例术后病理示切缘阳性。术后12例出现不同程度尿失禁，均在术后3月内恢复尿控。12例行盆腔淋巴结活检者均未发现阳性淋巴结，5例保留性神经患者中3例术后随访勃起功能良好。随访3～30个月，无尿道狭窄和尿失禁。结论腹膜外腹腔镜前列腺癌根治术是一种安全有效的手术方法．手术创伤小、患者恢复快，取得与开放前列腺癌根治术同样效果，值得推广应用。

Objective To evaluate the effectiveness of extraperitoneal laparoscopic radical prostatectomy, Methods A lolal of 53 patients diagnosed with localized prostate carcinoma were admilted from February 2003 to December 2006, whose serum PSA ranged from 7.5-47ng/ml （mean 14ng/ml）. The volume of the prostate ranged from 35-75ml （mean 52ml）. Biopsy was performed hefore operation and the pathological results revealed prostate carcinoma with Gleason sore no more than 7. CT, MR and ECT revealed no lymph node involvement or bone metastasis. The procedures were performed with antegrade techniques. Pelvic lymphadectomy was performed in 12 cases and nerve-sparing technique was performed in 5 cases. Results The operation duration ranged from 110-270 min （mean 190 min）. Intraoperative blood loss was 120-1200 ml （mean 320 ml）. Incontinence occurred in 12 cases in lhe early stage and recovered to normal within 3 months. Positive margin occurred in 4 cases. There was no eomplication of urethra stricture or incontinence during 3-30 months of follow-up. No positive lymph nodes were involved in 12 cases with pelvic lymphadectomy. Of the 5 patients who received nerve-sparing prostateetomy, 3 had normal erectile function （luring follow-up. Conclusions Extraperitoneal laparoscopic radical pmstatectomy is a safe, effective and efficient surgical procedure with minimal invasion, less morhidity and rapid recovery. Laparoscopic radical prostatectomy is emerging as an alternative to open radical prostatectomy.