基于“三面一尖”分离策略的3 Trocars腹膜外径路腹腔镜前列腺癌根治术(附49例报告)

Three-port extraperitoneal laparoscopic radical prostatectomy basing on “three interfaces and one apex” dissociated strategy(Report of 49cases)

目的:探讨基于"三面一尖"分离策略的3Trocars腹膜外径路腹腔镜前列腺癌根治术的手术经验。方法:回顾性分析2015年5月~2016年8月我院收治的49例前列腺癌患者的临床资料。患者年龄(69.1±6.0)岁,术前总前列腺特异抗原7~250μg/L。BMI(25.8±3.9)kg/m^2,平均Gleason Score为7.7(6~9)分。选择经腹膜外径路分别于脐下1cm、右侧麦氏点及左侧反麦氏点置入3个10mm套管,建立气腹后分别处理"前列腺耻骨面"、"前列腺膀胱面"、"前列腺直肠面"和"前列腺尖部",最后单针连续吻合后尿道与膀胱颈并将吻合口的前壁与耻骨后血管复合体固定。术后随访3、6个月并分析手术时间、出血量、围手术期并发症、手术切缘阳性率、术后控尿恢复时间和血清前列腺特异性抗原(PSA)值变化等情况。结果:49例腹腔镜前列腺癌根治术均获成功。手术时间97~170min,平均110min;出血量50~1 000ml,平均203ml。术后发生膀胱尿道吻合口狭窄1例,2例发生手术切缘阳性行内分泌治疗,术后3~6个月所有患者均恢复控尿。结论:"三面一尖"分离策略对于3Trocars腹膜外径路腹腔镜前列腺癌根治术的顺利完成至关重要。3Trocars腹膜外径路腹腔镜前列腺癌根治术不仅安全、可行,而且具有更好的美容效果。

Objective：To investigate three-port extraperitoneal laparoscopic radical prostatectomy basing on＂three interfaces and one apex＂dissociated strategy.Method：From May 2015 to August 2016,49 cases with localized prostate cancers were analyzed retrospectively,which were treated by three-port extraperitoneal laparoscopic radical prostatectomy basing on＂three interfaces and one apex＂dissociated strategy.Their mean age was（69.1±6.0）years old,the total PSA level was 7-250μg/L,and the mean body mass index（BMI）was（25.8±3.9）kg/m^2.The first 10-mm trocar was placed 1 cm under the umbilicus,for the 30°laparoscope.At the true and left McBurney point were placed 10 mm trocars respectively.The procedure of prostatectomy included ＂interface of pubic bone dissociation＂,＂bladder interface dissociation＂,＂rectum interface dissociation＂and ＂apex dissociation＂.The urethra and bladder neck were anastomosed with single needle and the anterior wall of the anastomosis was fixed with the posterior pubic vascular complex.All patients were followed up for three and six months,and the operation time,blood loss,perioperative complications,positive rate of surgical margins,postoperative recovery time and serum PSA value were analyzed.Result：Forty-nine cases of laparoscopic radical prostatectomy were successful.The operation time ranged from 97 to 170 min,with an average of 110 min.The bleeding volume ranged from 50 to 1 000 ml,with an average of 203 ml.After operation,one cases of urethral and urethral anastomotic stricture occurred,and endocrine therapy was performed in all of the two patients with positive surgical margin.All patients recovered continence after 3-6 months.Conclusion：＂Three interfaces and one apex＂separation strategy is essential for the successful completion of laparoscopic surgery for three-trocar extraperitoneal laparoscopic radical prostatectomy.Three-trocar extraperitoneal laparoscopic radical prostatectomy is safe,feasible and has better cosmetic results.