经腹膜外腹腔镜前列腺癌根治术9例临床分析

Clinical analysis of extraperitoneal laparoscopic radical prostatectomy for 9cases of prostate cancer

目的：探讨经腹膜外腹腔镜前列腺癌根治术的手术方法和疗效。方法：回顾分析我院为9例患者经腹膜外行腹腔镜前列腺癌根治术的临床资料,术中重视神经血管束、前列腺癌结节解剖位置、膀胱颈部及尿道的处理。结果：9例手术均获成功。手术时间280～600min,平均（364±97）m in,出血220～600ml,平均（372±122）ml。本组无切缘阳性病例,无大出血和直肠损伤等严重并发症发生。术后暂时性尿失禁者均在3个月内完全康复。8例3个月后阴茎勃起正常。结论：腹腔镜前列腺癌根治性术是一种相对完全、微创、并发症少、术后康复快的手术方法。

Objective：To investigate the operation skill and effects of extraperitoneal laparoscopic radical prostatectomy for prostate cancer.Methods：This series included 9 cases of prostate cancer aged 51-75 years old,mean 62 years.The PSA level ranged from 4.8μg/L to 26.4μg/L（mean,10.4μg/l）.TNM classification showed T1N0M0 tumor in two cases,T2aN0M0 tumor in five cases and T2bN0M0 tumor in two cases.Nine cases had normal penile erection preoperatively.They underwent extraperitoneal laparoscopic radical prostatectomy,and their clinical data were retrospectively analyzed. During operation, we paid attention to location of neurovascular bundle and tubercle of prostatic cancer, and treatment of bladder neck and urethra. Results ： All the operations were successful. The operative time was 280-600min, mean （364 ± 97） min, and the blood loss was （220-600） ml, mean （372 ±122） ml. No cases had positive margins and no severe complications occurred, such as hemorrhage or rectal injury. Postoperative temporary urinary incontinence improved after supportive treatment and was cured in 3 months after operation. 8 of all cases had normal penile erection in 3 months. Conclusions：The extraperitoneal laparoscopic radical prostatectomy,keeping the procedure out of the peritoneal cavity, with minimal invasion, few complications and rapid recovery, may be considered as a promising surgical method for patients with localized prostate cancer.