腹腔镜下前列腺癌手术直肠损伤的诊治探讨(附7例报告)

Diagnosis and treatment of rectal injury during laparoscopic radical prostatectomy:Analysis of 7 cases

目的:探讨腹腔镜下前列腺根治性切除术直肠损伤发生的危险因素以及处理原则。方法:回顾分析2010年1月至2021年6月湖州市中心医院泌尿外科收治的7例前列腺癌手术合并直肠损伤患者的临床资料,均行腹腔镜下前列腺根治性切除术,术中发现直肠完全破裂4例,其中2例术中行腹腔镜下直肠修补术,2例术中行腹腔镜下直肠修补+结肠造口术,直肠肌层损伤1例,行腹腔镜下直肠修补术。术后迟发性直肠破裂2例,二次手术行结肠造口+经肛直肠修补术。结果:7例患者直肠损伤都发生在前列腺尖部。术后病理分期pT2b~pT3b。Gleason评分7~10分。术后随访2~18个月,术中直肠修补的5例恢复良好,无并发症。术后二次直肠修补的2例,其中1例并发尿道直肠瘘,余1例恢复良好。结论:前列腺根治性切除术直肠损伤好发于前列腺尖部,术中发现行腹腔镜下一期修补疗效确切。同时应警惕尿道直肠瘘的发生。

Objective:To explore the risk factors and management principles of rectal injury during laparoscopic radical prostatectomy(LRP).Methods:We retrospectively analyzed the clinical data on 7 cases of LRP complicated with rectal injury and treated in Huzhou Central Hospital from January 2010 to June 2021.Four of the 7 PCa patients were found with complete rectal rupture during LRP,of whom 2 were treated by laparoscopic rectal repair(LRR)and the other 2 by LRR+colostomy during surgery.Another case of rectal muscle injury also underwent LRR.Two cases of delayed rectal rupture were observed postoperatively and treated by colostomy+transrectal repair in the second-stage operation.Results:The rectal injuries were found in the apex of the prostate in all the 7 cases,pathologically staged as pT2 b-pT3 b and with Gleason scores of 7-10.Postoperative follow-up lasted 2 to 18 months,during which the 5 cases of intraoperative rectal repair recovered well without complications,and of the 2 cases of postoperative rectal repair,1 made a good recovery and the other 1 developed rectourethral fistula.Conclusion:Rectal injury during radical prostatectomy tends to occur in the apex of the prostate and can be effectively managed by laparoscopic repair.Meanwhile,attention should be paid to the postoperative complication of rectourethral fistula.