经腹膜外入路腹腔镜前列腺癌根治术(附16例报告)

Extraperitoneal laparoscopic radical prostatectomy (a report of 16 cases)

目的总结经腹膜外入路腹腔镜前列腺癌根治术的临床体会。方法回顾性分析2010年10月至2011年12月,采用四孔经腹膜外入路行腹腔镜前列腺癌根治术治疗局限性前列腺癌患者16例的临床资料。结果本组16例手术全部顺利完成,9例同期行盆腔淋巴结清扫术,无一例中转开放。手术时间150～420min,平均270min。术中出血量50～2000ml,平均534ml,4例术中输血400～800ml,输血率25%。术后病理报告切缘阳性1例(6.2%)。术后4～15d出院,平均8d。所有患者留置尿管2周,拔除尿管后无真性尿失禁。随访3～17个月,8例昼夜控尿良好,8例白天偶有压力性尿失禁,其中1例术后4个月出现吻合口狭窄。9例患者术后可勃起,其中1例行保留神经的前列腺癌根治术患者术后1个月可正常进行性生活。结论经腹膜外入路腹腔镜前列腺癌根治术具有创伤小、出血少、操作容易、并发症少等优点,是开展腹腔镜前列腺癌根治术的较好选择。

Objective To investigate the clinical experience of extraperitoneal approach laparo- scopic radical prostatectomy. Methods From October 2010 to December 2011, 16 cases of local- ized prostate cancer were analyzed retrospectively, which were treated by extraperitoneal laparoscopic radical prostatectomy with four holes. Results 16 cases were all successfully completed, and 9 ca- ses underwent pelvic lymph node dissection at the same time, no cases were converted to open sur- gery. Median operative time was 270 （150-420） minutes. The mean blood loss was 534 （50-Z 000） ml, 4 cases （ZS~） had a blood transfusion 400-800 ml. 1 case （ft. 2~） had positive surgical mar- gins. Patients were discharged 4-15 days after surgery, with an average of 8 days. Urinary catheter was removed 2 weeks later, no true incontinence was observed. The duration of follow-up was 3 to 17 months, 8 cases were completely continent day and night, 8 cases had occasional stress urinary incontinence daytime, 1 patient had anastomotie stricture 4 months later. 9 cases could erectile post- operatively. One patient received preserving neurovascular bumdie surgery, and 1 month later the patient could have normal sexual life. Conclusions Extraperitoneal laparoscopie radical prostatec- tomy has the advantages of less trauma, less bleeding, easy operation, and fewer complications, and {t is a better choice for laparoscopic radical prostatectomy.