腹腔镜前列腺癌根治术治疗经尿道前列腺电切术发现的前列腺癌14例临床分析

Laparoscopic radical prostatectomy for prostate cancer found in transurethral resection of the prostate: Report of 14 cases

目的:总结腹腔镜前列腺癌根治术(LRP)治疗在经尿道前列腺电切术(TURP)中发现的前列腺癌的临床经验。方法:回顾我院自2011年至2016年应用LRP治疗在TURP手术发现的前列腺癌共计14例,对其临床资料及随访结果进行分析。结果:14例TURP后LRP均顺利完成。TURP与LRP时间间隔1~4个月。手术时间80~220(163±94)min。失血量100~500(188±152)ml。所有病例术中无直肠损伤;无中转开放手术;无输血;1例切缘阳性,肿瘤侵及脉管及神经。术后留置尿管时间7~16(11.7±3.7)d。淋巴瘘1例。术后随访中位时间28个月(4~68个月)。13例术后12个月时尿控满意,无尿失禁;1例随访不足12个月者未发生尿失禁。1例切缘阳性者给予术后放疗及内分泌治疗,目前肿瘤控制良好。其余13例随访中未发现生化复发及临床复发。结论:既往TURP手术会导致前列腺周围组织水肿、粘连、纤维化及膀胱颈部瘢痕愈合,增加后续的LRP手术的难度,但是在TURP术后实施LRP仍可获得了满意的功能及肿瘤学预后。术者应对上述困难应充分了解并重视,同时患者也应明确了解上述的手术的风险。并由经验丰富的医生来实施手术。TURP后1个月LRP似乎可以获得更好的解剖层面,降低手术难度。

Objective： To sum up the experience in the treatment of prostate cancer found in transurethral resection of the prostate（ TURP） by laparoscopic radical prostatectomy（ LRP）. Methods： Fourteen patients found with prostate cancer during TURP underwent LRP in our hospital between 2011 and 2016. We reviewed our experience in the treatment and analyzed the clinical and followup data. Results： LRP was successfully performed in all the cases at 1-4 months after TURP,with a mean operation time of（ 113± 94） min（ 80-220 min）,a mean blood loss of（ 188 ± 152） ml（ 100-500 ml）,a mean catheterization time of（ 11. 7 ± 3. 7）d（ 7-16 d）,and a median follow-up time of 28（ 4-68） months. There were no rectal injuries,conversion to open surgery,or blood transfusion during the operation. Positive surgical margin was found in 1 case,in which the tumor involved the nerve and vessel,and lymphatic fistula occurred in another. Urinary continence was desirable in 13 cases at 12 months after surgery,and no incontinence was observed in the other,which had been followed up for less than 12 months. The patient with positive surgical margin received radiotherapy and endocrine therapy postoperatively and was still alive without pathologic progression. No biochemical or clinical recurrence was found in the other 13 cases. Conclusion： LRP at 1 month after TURP can provide a proper anatomical plane,make the operation easier,and achieve a satisfactory functional and oncological prognosis for patients with prostate cancer.