经腹膜外途径腹腔镜前列腺癌根治术中尿控技巧探讨

Analysis of Methods and Skills for Urination Control in the Extraperitoneal Laparoscopic Radical Prostatectomy

目的回顾性总结探讨经腹膜外途径腹腔镜下前列腺癌根治术中处理尿控的方法及技巧。方法临床选择T1～T3a前列腺癌患者44例,年龄为58～82岁,平均年龄为70.5岁。术前前列腺总特异性抗原(TPSA)为8.9～38.6 ng/ml。所有患者术前均行经直肠前列腺穿刺活检,病理明确诊断证实为前列腺癌,平均Gleason评分(5.6±2.5)分,44例患者均行经腹膜外途径腹腔镜下前列腺癌根治术。结果 44例患者均顺利完成手术,手术时间150～410分钟,平均手术时间(220±85)分钟;术中出血量300～1500ml,平均(400±220)ml;术后完全尿控33例(75.0%),部分尿控9例(20.5%)(1周后恢复),完全性尿失禁2例(4.5%)(持续3个月以上),术后病理切缘阳性6例(13.6%);直肠损伤1例,经保守治疗治愈。结论腹腔镜下前列腺癌根治术治疗局限性前列腺癌安全、有效,术后尿控效果与术中神经血管束(NVB)、远端尿道保留长度、正确处理膀胱颈部、膀胱尿道吻合的技巧处理及术者的经验相关。

Objective To explore the methods and skills for urination control of extraperitoneal laparoscopic radical prostatectomy. Methods 44 patients was be collected,the age was from 58 y to 82 y,the average age was70. 5y. The total prostate specific antigen（ TPSA） before operation was 8. 9 - 38. 6 ng / ml. Every patient was performed transrectal prostate biopsy and diagnosed confirmedly as prostate cancer by pathology. The average Gleason was（ 5. 6 ± 2. 5）. 44 patients were all be performed the operation of extraperitoneal laparoscopic radical prostatectomy. Results 44 patients were all successfully completed the operation. The operation time was 150 -410minutes,and average time was（ 220 ± 85） minutes. After operations,33 cases could control the urination completely（ 75. 0%）,and 9 cases could control the urination partly（ recover in a week）. The total uracratia was 2 cases（ 4. 5%）（ last more than 3 months）,and the positive result of postoperative pathological cut edge was 6 cases（ 13. 6%）. 1 case was rectal injury,but was cured by conservation treatment. Conclusions It was safety and effective that using extraperitoneal laparoscopic radical prostatectomy to cure localized prostate cancer.The post- operation effect of urination control was related to intra- operation nerve blood vessel bundle（ NVB）,the reserved length of the distal urethra,operation the bladder neck accurately,the skill of handle with urethrovesical anastomosis,and the experience of surgeon.