腹膜外入路腹腔镜下前列腺癌根治术41例

Extraperitoneal laparoscopic radical prostectomy of 41 cases

目的熟悉腹膜外入路腹腔镜下前列腺癌根治术的手术方法,降低前列腺癌根治术的手术并发症的发生率。方法对2005年11月至2012年6月的41例腹腔镜下前列腺癌根治术患者的临床资料进行回顾性分析,患者年龄65-78岁,平均72岁,所有患者术前均获确诊,前列腺特异性抗原3.4-45.6ng/ml,〈4.0ng/ml3例,4-20ng/ml30例,〉20ng/ml8例。结果除1例中转开腹手术,其余均由腹腔镜完成,手术时间65-240min,平均125min,术中出血量80-700ml,平均120ml。术后轻度尿失禁6例,通过尿道括约肌锻炼后1-3个月后可满意控尿,术中保留性神经26例,其中19例术后勃起功能恢复,可以完成性交。术后病理均证实为前列腺癌,Gleason评分4-9分,切缘阳性1例,术后加用内分泌治疗。术后随访2个月-6年,生化复发9例,予内分泌治疗后控制满意,1例因其他疾病死亡。结论腹膜外入路腹腔镜前列腺癌根治术是治疗前列腺癌的重要方法,把握好关键步骤,仔细操作,可以达到安全、有效、创伤小的目的。

Objective To learn the procedure of extraperitoneal laparoscopic radical prostectomy and to limit the complications of radical prostectomy. Methods We performed the retrospective study among 41 patients （from Nov. 2005 to June 2012） undergoing the laparoscopic radical prostectomy. The mean age is 72 （from 65 to 78）, and all those were diagnosed with prostate cancer. The PSA was 3.4-45.6 ng/ml. 4.0 ng/ml, 4-20 ng/ml and 20 ng/ml was 3, 30 and 8 , respectively. Results We transferred 1 case from laparoscopy to opening surgery, and others were performed with laparoscopic procedure. The mean operation duration was 125 min （from 65 to 240 min）, mean bleeding was 120 ml （from 80 to 700 ml）, and there were 6 cases with little uroclepsia, satisfactory with urination after contract urethral sphincter for 3 months. We retained the neurovascular bundle in 26 cases, and the erectile function can recovery to intercourse among 19 cases. The pathologic exam demonstrated all the prostate cancer, and Gleason score was from 4 to 9. 1 case margin was positive, who had undergone the endocrine therapy. We had followed up all the cases from 2 months to 6 years. The biochemical recurrence was 9 cases, who had undergone endocrine therapy. One case died of other disease. Conclusions It is important to perform the extraperitoneal laparoscopic radical prostectomy to treat prostate cancer, characteristic of safe, effect and minimal cut, which critical and careful procedure may contribute to.