盆腔双叶拉钩在男性复杂盆腔膀胱和前列腺血管蒂处理中的应用

Application of pelvic double-slice retractor in the division of bladder and prostate pedicles in male patients with complicated pelvic anatomy

目的 探讨男性复杂盆腔患者膀胱和前列腺血管蒂处理方法的改进效果。方法男性膀胱癌患者43例。年龄49～75岁，平均58岁。30例体质指数（BMI）28．8～31．3kg／m2，平均29．7kg／m2。曾行膀胱部分切除术16例（同时行输尿管膀胱再植术4例）。43例均行B超、cT、膀胱镜检查。肿瘤单发8例，多发35例。肿瘤最大径1．6～4．5cm，平均3．6cm。均经病理证实为膀胱癌。临床分期：T2期30例，T3期13例。前列腺癌37例。年龄54～72岁，平均65岁。BMI29．5—32．7ks／m2，平均30．6kg／m2。临床分期：T2a期10例，T2a。期25例，T3a期2例。患者分别行根治性膀胱切除术（RC）及顺行根治性前列腺切除术（ARP），术中辅助应用盆腔双叶拉钩进行膀胱及前列腺血管蒂显露。结果80例手术均顺利完成。在盆腔双叶拉钩提供的良好显露条件下，膀胱及前列腺血管蒂处理准确、快速。无直肠及盆壁组织损伤。RC组处理血管蒂时间9—14min，平均12min；出血量20～50m1，平均30ml。ARP组处理血管蒂时间5—9min，平均7min；出血量10～35ml，平均20ml。结论盆腔双叶拉钩结构简单、操作方便、使用性能好，男性复杂盆腔患者ARP和RC术中辅助应用盆腔双叶拉钩行膀胱及前列腺血管蒂显露效果满意。

Objective To evaluate effectiveness of the applying pelvic double-slice retractor in the division of bladder and prostate pedicles in male patients with previous surgery history during radical eysteetomy （RC） and anterograde radical prostatectomy （ARP）. Methods The pelvic double-slice retractor was used to expose the bladder and prostate pedicles in 43 RC （30 cases with BMI 〉 28 kg/m2 , 16 cases had previous partial cystectomy） and 37 ARP （all cases with BMI 〉 28 kg/m2 ）. Results The pelvic double-slice retractor provided excellent exposure for the division of bladder and prostate pedicles. The handling of bladder and prostate pedicles became easy and safe without unnecessary bleeding and injury to the rectum. The median operating time to control the pedicles during RC and ARP were 12 min and 7 rain, and the average blood loss were 30 ml and 20 ml, respectively. Conclusion The use of pelvic double-slice retractor for the exposure of the bladder and prostate pedicles is simple and effective in male patients with complicated pelvic anatomy during RC and ARP.