耻骨后顺行前列腺癌根治术3O例临床体会

Clinical experience of antegrade radical retropublic prostatectomy in 30 patients

目的总结耻骨后顺行前列腺癌根治术的手术经验及疗效。方法采用耻骨后顺行前列腺癌根治术治疗前列腺癌患者30例。平均年龄64（51～73）岁。T1 8例、T2 15例、T3 7例。手术采用先离断前列腺底部和膀胱颈，游离双侧精囊及输精管并顺行向下分离直至前列腺尖部，紧贴前列腺尖部切断尿道，将尿道与膀胱颈重新吻合。结果30例手术顺利，手术时间平均150（75～240）min，术中出血量平均350（100～1600）ml，无直肠、输尿管等周围脏器损伤，无围手术期严重并发症。术后病理报告均为前列腺腺癌，切缘阳性4例。30例平均随访25（6～48）个月，均存活，排尿通畅，无尿失禁者。术前13例有勃起功能者术后7例（54％）恢复勃起功能。结论耻骨后顺行前列腺癌根治术并发症发生率低、出血量少，切缘阳性率低，手术效果良好。

Objective To discuss the experience of antegrade radical retropublic prostatectomy. Methods Thirty cases of prostate cancer were treated by antegrade radical retropublic prostatectomy. The mean age of patients was 64 years. There were 8 cases of T1, 15 cases of T2, and 7 cases of T3. The surgery included following procedures： Firstly the vesical neck was divided. Then the seminal vesicle and the prostate were freed from above downward. After the urethra was separated from the prostatic apex, the proximal end of urethra was sutured to the new vesical neck. Results All the 30 laparoscopic surgeries were accomplished successfully. The mean operative time was 2.5 hours. The mean blood loss was 350 ml in the operation. No ureteral injury, rectal injury and other severe complication was observed. Histopathologic study showed prostate cancer for all the cases. Four cases had positive surgical margins. All cases were followed up from 6 to 48 months （average 25 months） without dysuria and permanent incontinence. No death occurred. Sexual function recovered in 7/13（54%） cases after the operation. Conclusions Antegrade radical retropublic prostatectomy provides low complication, little bleeding and positive surgical margins. It is an effective and safe procedure to treat prostate cancer.