腹腔镜前列腺癌根治术中不同吻合方法对手术的影响分析

The Impact of Different Anastomotic Methods on Laparoscopic Radical Prostatectomy

目的:总结两种不同的尿道膀胱颈吻合方法对腹腔镜前列腺癌根治术的影响。方法:2009年1月～2010年3月我科对52例早期局灶性前列腺癌实施经腹膜外腹腔镜前列腺癌根治术,手术采用经腹膜外入路。患者随机分成两组,一组20例采用间断缝合方法,另一组32例采用连续缝合方法。首先将两根15 cm长3-0可吸收肠线末端打结固定,于膀胱颈6点处将两针自膀胱浆膜层向黏膜层穿出,线结位于浆膜层外并拉紧,两针分别向9点、3点方向与尿道吻合,最后在12点处将两线打结,完成吻合。结果:52例腹腔镜前列腺癌根治术均获成功,无一例中转开放手术。间断缝合组:尿道膀胱吻合用时25～41 min,平均32.6 min;出现短时间吻合口漏2例,分别为2天和3天;连续缝合组:尿道膀胱吻合用时11～27 min,平均17.7 min;出现短时间吻合口漏1例,2天后好转。结论:连续缝合方法可缩短手术时间,减少漏尿发生率。

Objective：To compare the effect of two different urethrovesical anastomosis methods applied in laparoscopic radical prostatectomy （LRP）. Methods：From Jan 2009 to Mar 2010, LRP was performed in 52 patients with localized prostate cancer. The patients were assigned into two groups by random： 20 of them was performed LRP by using interrupted suture, and 32 of them by running suture. When running suture was performed, the ends of two suture needles with 15 cm 3--0 absorbable catgut was knoted first, followed by 6 o＇clock suture in vesical neck from serosa to musoca, and then urethra was anastomosed by these two needles with vesical neck at 3 and 9 o＇clock respectively, at last these two pieces of catgut were knoted at 12 o＇clock of veaieal neck. Reults：The procedure was successfully completed laparoscopically in all 52 cases without transversion to open approach. The mean operating time for interrupted suture was 32. 6 min（range from 25 to 41 min）, while the mean operating time for running suture was 17. 7 min（range from 11 to 27 min）. 2 of the 20 patients with interrupted suture were suffered from temporary stomal leak for 2 and 3 days respectively, while only 1 of the 32 patients with continunous suture was suffered from a 2-days stomal leak. Conclusions： running suture method can shorten the operation time and reduce the incidence of urine leakage