腹腔镜前列腺癌根治术(附21例报告)

目的探讨腹腔镜前列腺癌根治术的手术技巧和疗效。方法 2005年3月～2008年9月,经腹腔途径行腹腔镜前列腺癌根治术21例(T1a3例,T1b4例,T2a6例,T2b8例),游离膀胱前间隙、盆筋膜,显露前列腺尖部,缝扎阴茎背静脉复合体后离断膀胱颈,游离切除精囊,重建膀胱颈并与尿道吻合。结果 19例手术获得成功,中转开放手术2例,其中阴茎背静脉复合体损伤1例,直肠损伤1例。手术时间155～450min,平均280min;术中出血量170～2500ml,平均470ml。术后病理报告切缘阳性1例。术后尿管留置10～40d,平均14d,无真性尿失禁发生。术后发生漏尿3例,尿道狭窄1例,均治愈。21例随访5～44个月,平均18.5月,PSA0～5.85ng/ml,平均0.23ng/ml,未发现局部复发和远处转移。结论腹腔镜前列腺癌根治术是治疗局限性前列腺癌的安全有效措施。熟练掌握盆腔解剖,预先处理阴茎背静脉复合体,膀胱颈重建和镜下吻合技术是成功实施手术的关键。     

腹腔镜前列腺癌根治术(附11例报告)

目的探讨腹腔镜前列腺癌根治术的应用价值。方法4例采用经腹腔途经,7例采用经腹膜外途经,手术切除前列腺、精囊、输精管壶腹,行膀胱尿道吻合。结果11例手术均获得成功,手术时间180~390min,平均304min。术中出血量300~1200ml,平均520ml。术后留置尿管时间12~28d,平均19.8d。无直肠损伤等并发症。术后住院时间12~24d,平均20d,无尿失禁及尿道狭窄。11例随访1~36个月,平均11个月,未发现肿瘤局部复发和远处转移,术后3个月前列腺特异抗原0~0.05μg/L。结论腹腔镜前列腺癌根治术是一种安全、有效的治疗方法。     

腹腔镜前列腺癌根治术

目的总结腹腔镜前列腺癌根治术的经验。方法2004年9月～2005年12月,我科对8例早期局限性前列腺癌行经腹腔腹腔镜前列腺癌根治术,游离前列腺直肠间隙达前列腺尖部,游离膀胱前间隙及耻骨后间隙,缝扎阴茎背深静脉后离断膀胱颈部,重建膀胱颈并与尿道吻合。结果8例腹腔镜前列腺癌根治术均获成功,无一例中转开放手术。手术时间270～420min,平均325min;术中出血量300～1600ml,平均580ml,其中1例由于术中损伤阴茎背深静脉大出血1600ml,需要输血4例。标本切缘阳性1例。术后膀胱尿道吻合口尿漏2例;术后2周拔除导尿管,出现尿失禁2例,1例尿失禁在随访6个月后尿控能力恢复,另1例尿失禁仍存在。8例术后随访10～24个月,平均16个月,排尿均通畅,未出现生化复发现象。结论熟悉前列腺的局部解剖、有良好的腹腔镜器械辅助及熟悉掌握各种腹腔镜下操作技术是开展此手术的关键。     

腹腔镜前列腺癌根治术一例报告

我们在动物实验基础上 ,于 2 0 0 0年11月成功完成 1例腹腔镜前列腺癌根治术 ,报告如下。资料与方法　患者 ,男 ,70岁。反复出现排尿困难 ,加重 1个月 ,于 2 0 0 0年 9月入院。直肠指诊前列腺Ⅰ° ,质韧 ,未触及硬结。血ＰＳＡ 17.6ｎｇ/ｍｌ,游离ＰＳＡ 0 .3ｎｇ/ｍｌ,ＰＳＡ密度 (ＰＳＡＤ) >0 .45。直肠Ｂ超示前列腺 4.2ｃｍ× 3.3ｃｍ× 3.1ｃｍ ,前列腺周围带见一低回声区。按国际标准于Ｂ超引导下行前列腺穿刺活检[1] 。病理报告 :外周带、移行带均发现低分化前列腺癌浸润。常规检查 :心、肺、肝、肾功能正常 ,全身骨扫描和盆腔ＣＴ未…     

非气腹腹腔镜下前列腺癌根治术11例报告

目的：探讨非气腹腹腔镜下前列腺癌根治术的可行性及疗效。方法2012年7月～2013年6月,行非气腹腹腔镜下前列腺癌根治术11例。前列腺特异抗原（PSA）（19．6±17．2） ng/ml,前列腺体积33～78 ml,平均41 ml。临床分期cT1期3例,cT2期6例,cT3期2例。取耻骨上正中切口3～5 cm,用手指钝性分离膀胱前间隙。在腹腔镜或示指引导下于双侧麦氏点下2 cm与脐下弧形穿出3个操作通道。应用悬吊器械提拉下腹壁创造操作的空间,30°腹腔镜通过脐部的通道进入,术者通过两侧的通道及下腹部的小切口进入器械操作。手术操作与传统的腹腔镜下前列腺癌根治术相同。结果11例手术顺利,手术时间（227±61） min,术中出血量（360±101） ml,无直肠损伤等严重并发症。术后病理均为前列腺腺癌,无切缘阳性。随访1～11个月,平均4个月,排尿通畅,无尿失禁。 PSA 0～0．21 ng/ml,平均0．11 ng/ml。结论非气腹腹腔镜下前列腺癌根治术微创、安全、有效。     

腹腔镜前列腺癌根治术42例报告

目的:探讨腹腔镜前列腺癌根治术(laparoscopic radical prostatectomy,LRP)治疗局限性前列腺癌的可行性并总结临床体会。方法:回顾分析2008年12月至2011年3月为42例前列腺癌患者行腹膜外入路腹腔镜前列腺癌根治术的临床资料。结果:42例手术均获成功,无一例周围脏器损伤。手术时间120～250 min,平均170 min。术中出血量120～750 ml,平均260 ml,11例术中输血400～600 ml。术后住院21～23 d,平均22 d。拔除导尿管时间18～22 d,平均20 d。6例患者术后7天内发生尿漏,均经充分引流和牵拉尿管后痊愈。25例出现轻～中度尿失禁,经提肛等辅助治疗,4～12周后明显缓解或消失。术后病检:pT1c14例,pT212例,pT3a16例。术后PSA均<4.0 ng/ml。结论:经腹膜外入路行腹腔镜前列腺癌根治术可行、安全、有效,患者创伤小、康复快、并发症少,值得推广应用。     

腹腔镜下前列腺癌根治术

近年来腹腔镜前列腺癌根治术(laparoscopic radical prosta-tectomy,LRP)成为治疗早期前列腺癌的又一种规范手术。它在保留开放性手术优点的同时,发挥其创伤小、出血少和视野清晰的特点。1992年Schuessler等报告第1例LRP,但因手术时间长(平均9.4h),与开放手术比较优势不大,故未再继续开展。1998年,法国医师Guillonneau和Vallancien再次开拓该项手术,改进和完善此技术,并将手术的关键技术标准化,使LRP在欧美和亚洲得到推广应用。LRP是泌尿外科腹腔镜手术发展过程中的一次最显著的进步。手术者在腹腔镜清晰的视野下,能更精细地和更有效…     

经腹膜外腹腔镜前列腺癌根治术（附9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。方法我科自2006年1月至2008年10月对9例前列腺癌患者行经腹膜外途径腹腔镜前列腺癌根治术,手术经腹膜外路径顺行切除前列腺,切开膀胱颈部前先以1-0可吸收线缝扎背血管复合体。结果9例手术均获得成功,无中转开放手术。手术时间180-510min,平均322min,术中出血量200-1500ml,平均433ml,术后48h内胃肠功能恢复,术后2～3d下床活动,无直肠损伤和吻合口尿漏出现。标本切缘阳性1例。1例患者术后半年仍有轻度尿失禁。其中7例患者随访5～33个月,未发现肿瘤局部和生化复发和远处转移;术后3个月前列腺特异性抗原0～0．1ng／ml。结论经腹膜外腹腔镜前列腺癌根治术是一种安全有效的手术方法,手术创伤小,患者恢复快,腹腔并发症少。但该手术难度较大,需要具有丰富腹腔镜操作经验的医生完成。     

腹腔镜下经腹膜外前列腺癌根治术(附25例报告)

目的 探讨经腹膜外途径腹腔镜下前列腺癌根治术在治疗前列腺癌中的价值。方法 2003年6月至2006年1月我院共收治前列腺癌患者25例，年龄62-78岁（平均68．5岁），病史2周-6年，所有患者均接受腹腔镜下前列腺癌根治术。结果 所有手术均顺利完成，手术时间210-380min，半均245min，术中出血量500-1200mL，（平均850mL，），所有患者均于术后2周拔除导尿管。3例出现尿漏，于拔管前消失；3例术后出现轻度尿失禁，经辅助治疗后好转，术后PSA0-0．08μg／L，随访1-10月，未见肿瘤复发。结论 腹腔镜下经腹膜外前列腺癌根治术是一种安全有效的治疗方法，术中视野清晰、止血可靠、创伤小、腹腔并发症少、患者住院时间短、恢复快，值得临床推广。     

经腹膜外腹腔镜前列腺癌根治术

自1997年Schuesswler等报道腹腔镜前列腺癌根治术(laparoscopic radical prostatectomy,LRP)以来,LRP由于其微创、良好的手术视野以及患者较快的恢复时间,逐渐得到普及.掌握这项技术有较长的学习过程,如何缩短这一学习过程,是泌尿外科医师关注的重点之一,本文回顾性分析2005年4月至2009年10月应用腹腔镜手术治疗的33例前列腺癌根治性切除术患者的资料,报导如下.     

The Window Sign: An Aid in Laparoscopic and Robotic Radical Prostatectomy

Aim:Certain steps of laparoscopic radical prostatectomy (LRP) and robotic radical prostatectomy (RRP), such as identification of seminal vesicles, bladder neck and retroprostatic dissections are technically challenging specially during initial experience. We describe an important land mark : “Window sign”, which helps significantly during the procedure. Methods: The seminal vesicles can be dissected either through the transperitoneal, subperitoneal or extraperitoneal approach. In transperitoneal approach the vas deferens, seminal vesicles and Denonvillier’s fascia are dissected posteriorly, and this plane is re-entered after division of the prostate from the posterior bladder neck, and with division of the Denonvillier’s fascia. The communication between the anteriorly and posteriorly dissected planes in the retrovesical and retroprostatic space is termed “the window.” Alternatively, in the RRP technique, bladder neck is divided anteriorly and posteriorly and vas deferens and seminal vesicle pulled out through this window. We have found that this window in transperitoneal, subperitoneal or extraperitoneal approach whether done during laparoscopic or robotic radical prostatectomy, allows to retract the vas deferens and seminal vesicles to elevate the prostate, facilitates control of the prostatic pedicles, helps in dissection of the prostate and assists in the identification and careful avoidance of the neurovascular bundles. Results: This window sign was identified on the basis of our experience of over 450 cases of laparoscopic and robotic anatomical radical prostatectomies. We have followed this step in all of the cases by either technique. Conclusion: The “window sign” is an important aid while performing laparoscopic and robotic radical prostatectomy. This technique helps the surgeon to achieve both the anatomic and oncologic goals of the nerve sparing, during anatomic radical prostatectomy.     

腹腔镜根治性前列腺切除术个体化神经保留的探讨

目的探讨腹腔镜根治性前列腺切除(laparoscopic radical prostatectomy,LRP)实施个体化神经保留技术的可行性和安全性。方法2012年6月~2018年6月,121例前列腺癌患者经多学科讨论,建议行神经保留手术。临床分期cT1期49例,cT2期72例。术前前列腺特异性抗原(prostate specific antigen,PSA)3.3~20(11.3±6.1)μg/L。活检Gleason评分5~8分,平均6.1分。先采用腹腔镜下完全筋膜内技术,再根据术前和术中快速病理结果,改行筋膜间或筋膜外技术。结果完全筋膜内技术101例(83%);由于术中见前列腺与周围筋膜粘连,可能存在肿瘤包膜外局部浸润而行冰冻切片检查20例,切缘阴性改为筋膜间技术13例(11%),切缘阳性转筋膜外技术7例(6%)。术后8例(7%)手术切缘阳性。随访6~71个月,平均33.6月,术后8~41个月生化复发15例(12%)。控尿率:术后拔除尿管即刻控尿85%(103/121),18例尿失禁患者术后6个月全部恢复。术后3个月、6个月勃起功能恢复到术前水平分别为42%(51/121)和57%(69/121)。结论腹腔镜实施个体化保留神经的LRP是安全可行的;根据术前和术中的临床评估,采用渐进式筋膜保留方法,能使肿瘤学和功能达到较理想效果。     

腹腔镜下经腹膜外途径前列腺癌根治术(附2例报告)

目的:探讨腹腔镜下经腹膜外途径前列腺癌根治术的手术方法和临床效果。　方法:2例前列腺癌患者, 腹腔镜下经腹膜外途径分离前列腺,切开膀胱颈部,分离前列腺尖部、游离精囊后顺行将前列腺切除,膀胱颈成形 后与后尿道吻合。　结果:手术时间分别为10、7h,出血量分别为1000、500ml。术后24h恢复肠道功能,3周后 拔除尿管,未出现并发症。　结论:腹腔镜下腹膜外途径前列腺癌根治术创伤小、视野清晰、出血少、恢复快,是早 期前列腺癌根治术的方法之一。     

Intraoperative Management of Robotic-Assisted Versus Open Radical Prostatectomy

Background and Objectives:

Minimally invasive surgery has been shown to decrease postoperative morbidity and length of stay for several laparoscopic procedures. We sought to retrospectively compare intraoperative surgical and anesthetic parameters, post-anesthetic care unit (PACU) length of stay, and hospital length of stay of patients who underwent robotic-assisted laparoscopic radical prostatectomy (RAP) versus open radical retropubic prostatectomy (ORP).

Methods:

A retrospective investigation was performed using a urologic surgery database and an anesthesia electronic medical record. We queried information regarding 106 ORP patients from 2002 through 2007 and 575 RAP patients from 2007 through 2008.

Results:

Patients in the RAP group compared with ORP patients had reductions in surgical time, anesthesia time, estimated blood loss, crystalloid administration, and PACU and hospital length of stays. Compared with ORP procedures, intraoperative respiratory rates, peak inspiratory pressures, and arterial pressures in RAP procedures were higher; tidal volumes and heart rates were decreased; but end-tidal carbon dioxide concentrations were not different. In the RAP group, intraoperative complications included severe bradycardia, corneal abrasions, and 2 patients required reintubation. Surgically, no rectal perforations were noted, and no operative mortalities occurred.

Conclusions:

Our data demonstrate the safety and efficacy of RAP due to a combination of surgical and anesthetic factors.     

Combined Robotic-Assisted Laparoscopic Partial Nephrectomy and Radical Prostatectomy

A 59-year-old man with a history of prostate cancer and clear-cell renal-cell carcinoma of the kidney underwent a combined robot-assisted laparoscopic partial nephrectomy and radical prostatectomy. We describe the initial report of a combined robot-assisted operation for both procedures concurrently with a port strategy allowing reuse of ports.     

Vattikuti Institute Prostatectomy: Technical Modifications in 2009

Background

Since we last published our technique of robotic prostatectomy, we have introduced three technical refinements: superveil nerve sparing, bladder drainage with a percutaneous suprapubic tube (PST), and limited node dissection of the obturator and internal iliac nodes in preference to the external iliac nodes in selected patients.

Objective

To describe selection criteria, to explain the three techniques, and to evaluate functional and oncologic results.

Design, setting, and participants

Single-institution study of 1151 radical prostatectomies performed from 2006 to 2008 by one surgeon.

Surgical procedure

The superveil nerve-sparing technique spares nerves from the 11-o’clock position to the 1-o’clock position. The bladder is drained with a PST rather than a urethral catheter. For low- or intermediate-risk disease, limited lymphadenectomy concentrates on the internal iliac and obturator nodes, excluding the external iliac lymph nodes.

Measurements

Erectile function and patient comfort were evaluated using questionnaires administered by a third party. Lymph node yield was quantified by a qualified uropathologist.

Results and limitations

At 6–18 months after surgery, 94% of men who attempted sexual intercourse were successful with a median Sexual Health Inventory For Men (SHIM) score of 18 out of 25. PST bladder drainage resulted in less patient discomfort; visual analog scores were 2 at 2 days after prostatectomy and 0 at 6 days after prostatectomy. The modified lymphadenectomy harvested few overall nodes, but it increased the yield of positive nodes >13-fold in patients with low-risk stratification (6.7% compared with 0.5%).

Conclusion

In this single-institution, single-surgeon study, these modifications improved erectile function outcomes, decreased catheter-associated discomfort, and enhanced the detection of positive nodes.