腹腔镜下耻骨后腹膜外保留尿道的前列腺切除术

Laparoscopic simple prostatectomy with prostatic urethra preserved for benign prostatic hyperplasia

目的探讨腹腔镜下经耻骨后腹膜外保留尿道的前列腺切除术治疗大腺体前列腺增生症的可行性。方法自2006年1月至2007年1月对9例前列腺增生症的病人采用腹腔镜行耻骨后腹膜外前列腺切除术,病人年龄为(77.8±6.8)岁,范围为(62～83)岁。经直肠前列腺B超显示前列腺大小为(101.3±36.2)g,范围为(62～172)g,均无明显中叶增生。腹腔镜手术包括耻骨后腹膜外腔的建立、排列成倒U字形5个穿刺套管的放置、前列腺被膜的切开、增生腺瘤的切除、前列腺部尿道的保护及前列腺被膜的缝合等主要步骤。结果9例病人手术顺利,术中出血(190±160.6)ml,范围为(60～600)ml,手术时间为(174±59.8)min,范围为(90～240)min。术后恢复顺利,尿管拔除时间为(8.4±3.8)d。术后3月复查病人尿流率、国际前列腺症状评分(IPSS)评分、生活质量评分(QOL)等较术前明显好转。术前有性功能的4例病人术后性功能无损。结论对腺体大的前列腺增生症行腹腔镜下经耻骨后腹膜外行前列腺切除术是可行的,病人创伤小、恢复快、效果满意。

Objective To explore the feasibility and technique of retropubic extraperitoneal laparoscopic simple prostatectomy with prostatic urethra preserved to treat large volume benign prostatic hyperplasia（BPH）. Methods From January 2006 to January 2007, laparoscopic simple prostatectomy with prostatic urethra preserved was performed in 9 patients with symptomatic BPH, and the age of patients was 77.8±6.8（range 62-83） years old. The transrectal ultrasound （TRUS） revealed BPH without a median lobe enlargement and estimated prostatic gland weight was 101.3±36.2 （range 62-172） g. The technique included retropubic extraperitoneal space produced by balloon dilation, five trocars in a reverted U shape placed, transverse prostatic capsular incision made, subcapsular plane developed, prostatic adenoma removed while prostatic urethra preserved as well as prostatic capsule sutured. Demographic, perioperative and outcome data were recorded. Results The mean operative time was 174±59.8 （range 90 to 240） min and the estimated blood loss was 190±160.6 （ 60 to 600） ml. Blood transfusion was not necessary in this group of patients. The average Foley catheter preserved duration was （8.4±3.8） days. Significant improvement was noted in the maximum flow rate, the International Prostate Score Symptoms （IPSS） and the quality of life questionnaires （QOL） three months after surgery. No incontinence happened in these 9 patients. Interestingly, 4 patients with normal erection before surgery regained sexual activity after surgery and the ejaculation was antegrade. Conclusion Laparoscopic simple prostatectomy with prostatic urethra preserved for large benign prostatic hyperplasia is feasible and reproducible. Postoperative bladder irrigation can be avoided and antegrade ejaculation is preserved.