经腹膜外腹腔镜下前列腺癌根治术(附151例报告)

Extraperitoneal Laparoscopic Radical Prostatectomy(Report of 151 Cases)

目的:探讨经腹膜外腹腔镜下前列腺癌根治术(ELRP)的手术技巧和疗效。方法:回顾分析2006年1月～2011年1月,行ELRP 151例患者的临床资料。术前均经病理检查确诊,患者平均年龄69(53～78)岁,盆腔CT、MRI和核素全身骨扫描无盆腔淋巴结、精囊和骨转移。结果:术前TPSA平均16.40(3.27～165.00)μg/L,Gleason评分<7分63例(41.7%),7分58例(38.4%),>7分30例(19.9%)。平均手术时间178(60～390)min,平均出血量260(20～1 000)ml,术中输血5例(3.3%)。直肠损伤1例(0.67%),术后病理检查切缘阳性14例(9.3%),局部闭孔淋巴结转移5例(3.3%)。术后留置导尿平均13.5(6～69)天,平均住院时间14.4(4～74)天。术后随访平均27(4～62)个月,不同程度尿失禁31例(20.5%)。尿道狭窄2例(1.3%),均行尿道狭窄冷刀切开。单侧腹股沟斜疝2例(1.3%),出现生化复发15例(9.9%)。结论:ELRP是安全可行的,创伤小,术后恢复快。镜下吻合技术和控制出血是手术成功的关键。

Objective： To probe into the skill and effect of extraperitoneal laparoseopic radical prostatectomy （ELRP）on patients with prostate cancer. Methods： From January 2006 to January 2011, extraperitoneal laparo- scopic radical prostatectomy was performed on 151 men,mean aged 69 （range 53 to 78） years,who were appropriate candidates for radical retropubic prostatectomy. Patient characteristics, surgical statistics, and pathologic re- sults were prospectively collected. CT,MRI and ECT revealed there was no lymph node or seminal vesicle involve- ment and there was no bone metastasis. Results：The mean preoperative prostate-specific antigen level was 16.40 ng · ml-1 （range 3.27 to 165.00）. The preoperative Gleason sum was less than 7 in 63 patients （41.7%） ,7 in 58 （38.4 %）, and more than 7 in 30 patients （19.9 % ）. The mean operating time was 178 minutes （range 60 to 390）. The estimated blood loss averaged 260 ml （range 20 to 1 000） ,and 5 patients （3.3%） required blood transfusions. One （0.67%） was compilicated by rectal injury. Positive surgical margins were reported in 14 specimens （9.3%）. 5 （3.3 ~） case was found having obturator lymph node metastasis. The mean catheterization time was 13.5 （range 6 to 69） d,The mean length of hospital stay was 14.4（range 4 to 74） d. There was 2（1.3%）complication of ure- thra stricture during mean 27（range 4 to 62） months follow-up and was underwent surgery, 2 （ 1.3 %） unilateral Inguinal hernia, 31 （20.5 % ） incontinence and 15 （9.9% ） biochemical recurrence. Conclusions： Extraperitoneal lapa- roscopie radical prostatectomy is an effective and safe approach for localized prostate cancer. Control of hemorrhage and laparoscopic suture technique are the keys to successful operation.