经腹膜外腹腔镜前列腺癌根治术（附7例报告）

目的：探讨经腹膜外腹腔镜前列腺癌根治术的手术方法和疗效.方法：对7例局限性前列腺癌患者实施经腹膜外前列腺癌根治术.结果：7例手术均成功完成,手术时间145～250 min,平均175 min.估计术中出血量200～600 ml,平均300 ml,其中3例患者输400 ml红细胞悬液,术中无腹膜破裂、直肠输尿管损伤、膀胱损伤等病例;术后病理均报告切缘阴性,无淋巴结转移,留置导尿14～23天,平均18.2天;术后1～3天肠道功能恢复,平均1.6天.术后发牛尿漏2例,6天后尿漏消失.随访3～10个月,平均6个月,术后拔除尿管出现轻度尿失禁3例（43%）,1周内完全恢复尿控率71.4%（5/7）,第1、3、6个月完全恢复控尿率分别为71.4%（5/7）、85.7%（6/7）、100%（7/7）,术后3个月检查血清PSA＜0.2 μg/L,随访期间末出现生化复发.结论：腹腔镜下腹膜外途径前列腺癌根治术创伤小、并发症少、恢复快,是局限性前列腺癌安全有效的外科治疗方法.

Extraperitoneal Laparoscopic Radical Prostatectomy for Prostate Cancer:Report of 7 Cases

Objective：To evaluate the surgery skill and effects of extraperitoneal laparoscopic radical prostatee tomy for prostate cancer. Methods： 7 patients with localized prostate cancer underwent extraperitoneal laparoseopie radical prostatect-omy （ELRP）. Results： All the operations were successful, Mean operating time was 175 rain （range 145 to 250 min）. Mean blood loss was 300ml（range 200 ml to 600 ml）. Three of the seven patients received dtransfusion with MAP of 2 units. No major complications occurred, such as peritoneum injury ,rectal injury,ure teral injury or bladder injuries. Positive margins and positive lymph nodes were not reported in all cases. Mean catheterization time was 18.2 d （range 14 d to 23 d）. The bowel activity was recovered withln 1.6 days（range 1 days to 3 days）. Urine leak occurred in 2 cases,but were recovered without any intervention after 6 days. The du ration of follow up was 3-8 months（6 months on average）. Postoperative temporary urinary incontinence occurred in 3 eases（43 %）, but 1 recovered with 7 day after supportive treatment. Continence gained postoperatively：within one week after catheter removed in 5 cases （71.4 % ）, 1,3 and 6 months after surgery in 5 （71.4 % ）, 6 （85.7 % ） and 7（100%）cases,respectively. The value of serum PSA was 〈0.2 μg/L. PSA recurrence did not occurred in 7 ca ses. Conclusions：The extraperitoneal laparoscopic radical prostatectomy may be considered as an effective and safe surgical approach for localized prostate cancer, with minimal invasion, few complications and rapid recovery.