腹膜外途径腹腔镜下前列腺癌根治术

Extraperitoneal laparoscopic radical prostatectomy for prostate cancer

目的探讨腹膜外途径腹腔镜前列腺癌根治术的临床效果。方法前列腺癌患者82例,年龄为60～75岁,中位年龄为68岁。前列腺特异性抗原(PSA)为0.7～23.6ng/mL。TNM分期为T1N0M011例,T2N0M066例,T3aN0M05例。所有患者均于术前行前列腺穿刺活组织检查,或前列腺电切术后经病理检查证实为前列腺癌,均行腹膜外途径腹腔镜前列腺癌根治术。结果82例患者均顺利完成手术,手术时间为150～380min,平均为(210±85)min;术中出血量为400～1200mL,平均为(600±230)mL,出血量>500mL者给予输红细胞悬液200～800mL。术后病理检查结果显示肿瘤切缘为阳性的3例患者术后加用全雄激素阻断治疗3个月。所有患者均于术后2周拔除导尿管,3例术后出现轻度尿失禁的患者经提肛训练等辅助治疗3个月后好转,能自主排尿。术后随访45例,随访时间为3～24个月,中位随访时间为16个月;术后3个月时PSA为0.02～0.10ng/mL,平均为(0.040±0.016)ng/mL。其中局部复发2例,采用辅助内分泌治疗或近距离放射治疗后控制;生化复发26例,采用辅助内分泌治疗控制。结论腹膜外途径腹腔镜下前列腺癌根治术安全、有效。

Objective To evaluate the clinical efficacy of extraperitoneal laparoscopic radical prostate ctomy for prostate caneer. Methods Eighty-two patients with prostate cancer, aged 60-75 years（mean,68 years）, were included in the present study. The prostate-specific antigen （PSA） level ranged 0.7-23.6 ng/mL. TNM classification showed TlN0M0 tumor in 11 cases,T2N0M0 tumor in 66 and T3aN0M0 tumor in 5. All cases underwent extraperitoneal laparoscopic radical prostatectomy. The functional reconstructive technique was performed during the procedure, which consisting of preservation of the urethral and bladder outlet sphincter muscles and reconstruction of the bladderneck. Results The operation was successful in all the 82 patients. The operative time was 150-380 min （mean [210±85] min）,and the blood loss was 400-1 200 mL （mean,[600±230] mL）. All the catheters were removed 2 weeks after surgery. Mild urinary incontinence was noticed occurred in 3 cases,and it was improved after supportive treatment. Forty-five cases were followed up for 3-24 months （mean16 months） after operation. Three months after operation the PSA level was 0.02-0.10 ng/mL （mean [0.040±0.016] ng/mL）. Two cases with local recurrence received adjuvant endocrine therapy or brachytherapy, and 26 cases with biochemical recurrence received adjuvant endocrine therapy. Conclusion Extraperitoneal laparoscopic radical prostatectomy is safe and effective for the treatment of prostate cancer.