腹腔镜前列腺癌根治术临床体会(附18例报告)

目的:探讨腹腔镜前列腺癌根治术的临床体会及其应用价值.方法:总结2007年7月～2011年4月应用腹腔镜行前列腺癌根治术18例患者进行回顾性研究,患者年龄54～ 78岁,中位年龄64.4岁.其中T1期患者6例,T2期12例.术前均病理证实为前列腺癌,均采用经腹膜外途径腹腔镜根治手术.结果:17例手术顺利,1例中转开放,平均手术时间230min,平均出血量约310ml,2例术中输血,无直肠损伤病例.术后留置导尿管时间12～21 d,平均16.7 d;2例尿道狭窄,4例发生漏尿,均经保守治疗后痊愈；1例切缘阳性.随访6～51个月,平均28个月,除2例尿道狭窄所有患者排尿通畅,2例有轻微遗尿.随访期间未发现有肿瘤局部复发和远处转移,无死亡病例,半年后血清前列腺特异性抗原在0～0.15 rg/ml之间.结论:腹腔镜前列腺癌根治术具有视野清楚、创伤小、出血及并发症少等优点,是一种安全、有效的治疗方法.

Clinical Experience of Laparoscopic Radical Prostatectomy (A Report of 18 Cases)

Objective:To report the clinical experience of laparoscopic radical prostatectomy(LRP) in the treatment of prostate cancer and evaluate its clinical value.Methods:From July 2007 to April 2011,18 patients whose age was from 54 to 78(mean,64.4)was done with LRP.All patients were diagnosed by pathology,and extraperitoneal operating approach was used to them.Among all the cases,6 cases of patients with stage T1, T2 stage 12 patients.Results:The operation was successfully performed in 17 cases except one who received open surgery.The mean time of operation was 230 minutes,and the mean blood loss was 310 ml.2 cases received transfusion in the operation.The postoperative catheterization time was 12～21 d(mean,16.7 d).There was no injury of rectum in all cases.Urine leak occurred in 4 cases,but recovered with conservative therapy;mild incontinence and urethral stricture occurred in 2 case respectively,all cases void with a good stream except 2 cases,1 case had positive surgical margins.The patients were followed up for 6～51 months(mean 28 months),local recurrence or distant metastasis was not found.Serum PSA was 0～0.15 ng /ml after 6 months.No death event occurred.Conclusion:With the advantages of good operating field,minimal invasion,less complications and blood loss,LRP is a safe and effective method in the treatment of prostate cancer.