腹腔镜前列腺癌根治术后自动结扎夹移位的原因分析及防治对策

Analysis and prevention of Hem-o-lok displacement after laparoscopic radical prostatectomy

目的分析腹腔镜前列腺癌根治术(LRP)术后自动结扎夹(Hem-o-lok)移位导致膀胱结石的原因,探讨预防LRP术后膀胱结石发生及其治疗的方法。方法回顾性分析2014年1月至2019年12月中山大学附属第三医院收治的12例LRP术后发生Hem-o-lok移位致膀胱结石病例资料,包括手术方案、术中情况、Hem-o-lok放置部位及数量、吻合口张力、膀胱碎石术中所见等,分析Hem-o-lok移位致膀胱结石的可能因素。结果12例患者病理分期T1a-T2cN0M0,均行经腹腔/腹膜外LRP,术中在吻合口附近使用Hem-o-lok 1~2枚,在前列腺侧韧带附近使用Hem-o-lok 4~8枚,术后6~15个月出现膀胱结石1~2颗,结石核心为Hem-o-lok,其中2例合并吻合口狭窄,1例合并吻合口Hem-o-lok嵌顿。采用经尿道狭窄环冷刀切开及瘢痕电切术处理膀胱颈狭窄,气压弹道碎石及取出Hem-o-lok,术后痊愈出院。结论在LRP术中,合理使用Hem-o-lok以及熟练的吻合技术,是预防术后吻合口狭窄及减少其移位形成膀胱结石的关键。

Objective To analyze the causes of Hem-o-lok displacement and bladder stones after laparoscopic radical prostatectomy(LRP),and to discuss the prevention and treatment of bladder stones after LRP.Methods The data of 12 cases of bladder stones caused by Hem-o-lok displacement after LRP from January 2014 to December 2019 in the Third Affliated Hospital of Sun Yat-sen University,including the surgical plan,intraoperative situation,Hem-o-lok placement sites and number,anastomotic tension,bladder lithotripsy,etc.were analyzed retrospectively.Results The pathological staging T1 aT2 cN0 M0 of 12 cases were performed by intraperitoneal/extraperitoneal LRP.During the operation,1-2 Hem-o-lok were used near the anastomosis and 4-8 Hem-o-lok were used near the lateral ligament of the prostate.There were 1-2 bladder stones appeared 6-15 months after the operation,and the core of the stones was Hem-o-lok.Among them,2 cases had anastomotic stenosis and 1 case had anastomotic incarceration.It took transurethral stenosis ring cold knife incision and scar electrotomy to treat bladder neck stenosis,pneumatic ballistic lithotripsy and Hem-o-lok removal,and all patients were cured and discharged.Conclusions In LRP,the rational use of Hem-o-lok and skilled anastomosis technique are important to prevent anastomotic stenosis and reduce its displacement to form bladder stones.