TURP术后前列腺癌根治术9例报告及文献复习

Radical prostatectomy after previous TURP:report of 9 cases and short review of literatures

探讨TURP术后偶发前列腺癌行开放及腹腔镜前列腺癌根治术的手术技巧及经验,并比较其优劣。方法:回顾性分析2007年1月～2012年4月两个中心收治的TURP术后病检所发现的偶发前列腺癌患者9例,TURP术后平均(12.0±3.6)周行前列腺癌根治术,其中开放和腹腔镜下前列腺癌根治术分别为5例和4例。结果:患者平均年龄67岁,9例手术顺利完成,全部经腹途径进行手术。开放手术组平均手术时间(220.1±40.2)min,术中平均出血(212.5±110.6)ml;腹腔镜组平均手术时间(321.3±68.7)min,术中平均出血(110.2±51.7)ml,术后平均随访(18.4±10.4)个月,最长30个月,9例均存活,8例控尿功能好,无明显尿失禁,1例站立位时尿失禁。9例患者监测PSA均小于0.2μg/L。结论:TURP术后行前列腺癌根治术对于偶发前列腺癌疗效满意,先前的TURP术增加了手术操作难度,应结合解剖结构改变采取相应的手术策略。与开放手术相比,腹腔镜手术具有解剖清楚、失血量少、术后尿控好的优点。

Objective： To evaluate the surgical possibility, dif？ culty and technics of patients who underwent radical prostatectomy （RP） after previous TURP. Methods：From January 2007 to April 2012,9 patients with inci- dental prostate cancer after TURP were treated with radical prostatectomy through either open or laparoscopic ap- proach. The patients underwent radical prostatectomy （12.0 ±3.6） months after TURP. Results： The mean age of our series was 67 years. All 9 cases were successfully treated,including 5 cases of open RP and 4 cases of laparo scopic RP. All cases were performed with transperitoneal approach. Mean operation times of open and laparoscop- ic RP were（220. 1 ±40.2）rain and（321.3±68.7）rain respectively,mean blood loss was （212.5±110.6）ml and （110.2 ± 51.7） ml accordingly. The mean follow-up was （ 18.4 ± 10.4） months with the longest follow-up of 30 months. All nine patients survived,and 8 of them had normal urinary function, without any incontinence. One case developed incontinence when he stood up. PSA suvillance in all 9 cases shown value of less than 0.2 μg/L during the period of follow-up. Conclusions：Although radical retropubic prostatectomy is technically more difficult after previous prostate surgery,it can be performed safely and satisfied with either open or laparoscopic approach by good training and anatomical understanding. Laparoscopic RP was with better visual field,less blood loss and better uriary function than open surgery.