经腹膜外腹腔镜前列腺癌根治术的关键点及操作技巧(附33例报告)

Surgical Experience and Operating Techniques of Extraperitoneal Laparoscopic Radical Prostatectomy:a Report of 33 Cases

目的:总结经腹膜外腹腔镜前列腺癌根治术治疗前列腺癌的手术经验和操作技巧。方法:2006年1月～2010年3月对33例前列腺癌患者行经腹膜外腹腔镜前列腺癌根治术,手术经腹膜外顺行路径切除前列腺,切开膀胱颈部前先以1-0可吸收线缝扎背血管复合体,采用单针连续吻合法进行膀胱与尿道的吻合。结果:33例手术均获得成功,无中转开放手术。手术时间120～575 min,平均234 min,术中出血量100～1 500 ml,平均320 ml,术后48小时内胃肠功能恢复,术后1～2天下地活动,没有直肠损伤和吻合口尿漏出现。标本切缘阳性1例。2例术后出现轻度尿失禁。2例出现尿道狭窄。对其中31例患者随访3～51个月,未发现肿瘤局部和生化复发和远处转移;术后3个月前列腺特异性抗原0～0.1μg/L。结论:经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。熟悉前列腺局部解剖及熟练掌握各种腹腔镜下操作技术是手术成功的关键。

Objective：To summarize surgical experience and operating skills of extraperitoneal laparoscopic radical prostateetomy. Methods： A total of 33 patients diagnosed prostate cancer underwent extraperitoneal laparoseopic radical prostatec tomy from January 2006 to March 2010. The procedures were performed with antegrade techniques. Before the bladder neck transaction, the retropubic dorsal vein complex was sutured with 1--0 absorbable suture. The single needle running suture method was used for urethrovesical anastomosis. Results： All operations were successful without converting to open surgery. The operation time ranged from 120 to 575 rain with a mean of 234 min, the intraoperative blood loss was 100 1 500 ml（mean, 320 ml）. The bowel activity was recovered with 48 hours after surgery. The patients were ambulant 1 to 2 days postoperatively. No rectal injury and uri- nary leakage were seen in this group. Positive margin was found in one case. Mild urinary incontinence occurred in 2 cases. Urethral stenosis occurred in 2 cases. During the following period of 3-51 months for 31 cases, no local recurrence or distant metastasis were found. The postoperative PSA level was 0 0. 1 μg/L. Conclusions： Extraperitoneal laparoscopie radical prostatectomy is safe and effective for the treatment of prostate cancer. It is important to master the anatomy of the prostate and the laparoscopic technique for extraperitoneal laparoseopic radical prostatectomy.