3D 腹腔镜下前列腺癌根治术的护理配合

目的：了解3D 腹腔镜下前列腺癌根治术情况。方法回顾性分析24例3D 腹腔镜下前列腺癌根治术的护理配合。对24例前列腺癌患者术前做好各项检查及准备,术中熟练掌握配合要点,熟悉手术仪器的性能和使用方法,严密观察手术进展,提供各项有效护理措施。结果手术时间平均103 min,手术均顺利完成,未发生手术并发症,术后恢复良好。手术费用与普通腹腔镜相同,没有额外增加患者手术费用。结论3D 腹腔镜下前列腺癌根治术是近年来开展的新手术,手术技术难度大,仪器设备依赖性强,对术中护理配合要求高,其良好的手术效果与正规培训、充分的术前准备、良好的沟通、设备的有效管理密不可分。     

PK刀在腹腔镜下前列腺癌根治术中的应用及配合护理

目的探讨PK刀在腹腔镜下前列腺癌根治术中的应用及配合护理。方法回顾性分析55例腹腔镜下使用PK刀实施前列腺癌根治术的手术患者。结果手术时间4～5h（平均4.6h）,术中出血量约（240～330）ml,无手术并发症,无使用不当而损坏PK刀及机器等异常发生。结论使用PK刀腹腔镜下前列腺癌根治术创伤小、出血少、恢复快。护士熟悉PK刀的性能、术中的使用、术后的护理管理,熟练掌握手术步骤密切配合是取得手术成功的关键。     

腹腔镜下前列腺癌根治术围手术期护理干预的实施

目的:分析围手术期护理干预对腹腔镜下前列腺癌根治术患者的实施效果。方法:选择105例腹腔镜下前列腺癌根治术患者作为研究对象,其中51例患者采取常规腹腔镜手术护理,作为对照组,占48.57%;另外54例患者采取围手术期护理干预,作为观察组,占51.43%;以手术时间、并发症发生率及护理满意度等作为观察指标。结果:两组患者均顺利完成手术,无严重并发症发生,但观察组手术时间、术中出血量、术后住院时间、VAS评分、并发症发生率及护理满意度均优于对照组,差异显著(P0.05)。结论:围手术期护理干预可促进腹腔镜下前列腺癌根治术的顺利开展,对于加快术后康复、改善预后均具有积极作用。     

高危前列腺癌患者行腹腔镜前列腺癌根治术的围手术期护理效果分析

目的研究与分析高危前列腺癌患者行腹腔镜前列腺癌根治术的围手术期护理效果。方法选取我院收治的高危前列腺癌患者20例为对象进行研究,回顾性分析其全部的临床资料,所有患者均实施腹腔镜前列腺癌根治术治疗,并实施围手术期护理干预。总结分析其手术情况及护理效果。结果经治疗,20例患者手术成功率为100%,手术时间200～290 min,平均(210±25)min,术中出血量280～550 mL,平均(320±24)mL。而经护理后,20例患者均安全度过围手术期,且未出现任何严重并发症,均顺利康复出院。结论高危前列腺癌患者行腹腔镜前列腺癌根治术时加强围手术期护理的效果非常显著,即可有效避免各种并发症,且还能确保患者病情更快恢复,因此值得推广应用。     

围手术期护理干预对腹腔镜下前列腺癌根治术疗效的影响

目的观察在腹腔镜下行前列腺癌根治术的围手术期护理对治疗效果的影响。方法 26例腹腔镜下根治手术治疗前列腺癌患者,随机分为对照组与护理组,每组13例。对照组采用常规护理,护理组进行围手术期护理干预,观察两组患者术后并发症及预后,同时调查患者对护理的满意程度。结果对照组手术出血量、手术时间、住院时间及并发症的发生情况均高于护理组(P<0.05);护理组患者护理满意度为92.31%,对照组患者护理满意度为61.54%,比较差异具有统计学意义(P<0.05)。结论对行前列腺癌根治术的患者进行围手术期护理干预,可以有效地减轻患者心理负担及恐惧,提高患者术后恢复情况,帮助患者早日康复。     

腹腔镜下前列腺癌根治术的手术配合

目的总结35例腹腔镜下前列腺癌根治术的手术护理和配合经验。方法分析35例行腹腔镜下前列腺癌根治术的Tlb～T2期患者的临床资料,进行术前心理护理,按Monstouris法行积极手术护理配合,术后反馈患者情况及护理质量。结果35例手术成功,平均手术时间为300min,平均出血量为350ml,8例出现术后并发症（直肠损伤、尿漏等）,术后随访无局部复发及远处转移。结论此手术方式效果确切、出血少、并发症少,积极手术配合及护理有助于减轻患者心理负担、提高手术成功率。     

腹腔镜下前列腺癌根治术的护理

目的 探讨腹腔镜下前列腺癌根治术患者的护理方法,分析总结相关临床护理经验.方法 回顾性分析我院2010 年6 月至2011 年6 月收治的共48 例腹腔镜下前列腺癌根治术患者的临床资料.结果 通过对行腹腔镜下前列腺癌根治术患者围术期采取全面的护理措施后,本组所有患者均临床治愈,康复出院.结论 对腹腔镜下前列腺癌根治术患者做好充分的术前准备和护理,密切的术中配合及术后细致的病情观察并采取有效的护理措施,能有效的提高护理质量,减少术后并发症,提高生存质量.     

25例腹腔镜Pca根治术的围手术期护理体会

目的总结腹腔镜前列腺癌（Pca）根治术围手术期的护理。方法于2003年6月至2008年6月共对25例Pca患者进行腹腔镜根治术,并在手术结束后在医院进行了术后恢复。对围手术期进行综合护理工作,总结护理经验。结果 25例Pca患者腹腔镜手术均顺利完成,无一例中转开放式手术;术后10～14d出院;术后2d患者开始排气,3d开始进行活动;其中4例患者呈切缘阳性,8例出现了尿漏。结论腹腔镜Pca根治术对患者的创伤性小,患者恢复好,配合科学的围手术期护理,可以使患者迅速康复。     

腹腔镜下经腹膜外途径前列腺癌根治术围手术期的护理

腹腔镜下经腹膜外途径前列腺癌根治术侵入性小、腹内并发症少、术后患者康复快。我院于2003年11月开展2例腹腔镜下经腹膜外途径前列腺癌根治术,获得成功,现将护理体会报道如下。     

前列腺癌根治术不同入路的疗效分析和比较

目的观察经耻骨后入路腹腔镜前列腺癌根治术(LRP)、经腹腔入路LRP与耻骨后前列腺癌根治术(RRP)治疗局限性前列腺癌的疗效。方法根据手术方式和手术入路的不同,将48例行前列腺癌根治术的前列腺癌患者分为经腹入路LRP组13例、RRP组11例、耻骨后入路:LRP组24例,并且将耻骨后入路LRP组分两亚组,比较各组疗效。结果 RRP组平均手术时间明显短于LRP组;术中出血量、平均留置导尿时间、术后住院天数均长于LRP组;经腹腔入路LRP组术后住院时间、术后肠道功能恢复时间均长于经耻骨后入路LRP组,两组比较有统计学意义(P<0.05),平均导尿留置时间和引流管去除时间均短于经耻骨后入路LRP组;LRP前新辅助治疗组与未行新辅助治疗组,两组数据无明细差异。结论 LRP具有手术出血少、术后恢复快等优点,控瘤效果、尿控效果与RRP相一致。经腹LRP患者术后恢复时间较长,但手术缝合简单,留置导尿时间等较经耻骨后LRP。     

耻骨后前列腺癌根治术32例临床分析

目的探讨耻骨后前列腺癌根治术的手术效果,并总结其经验。方法对32例诊断为B1期及B2期的前列腺癌患者行耻骨后前列腺癌根治术。结果平均手术时间3．4h,术中平均出血量560mm。术后3个月PSA、术后6个月最大尿流率、平均尿流率、剩余尿及前列腺症状评分与术前比较差异有统计学意义（P〈0．05）。术后病理报告：肿瘤均局限于包膜内。随访6—24个月,平均14个月,均存活。无直肠、输尿管损伤,无完全性尿失禁及手术死亡发生。术后1～2个月患者均恢复完全控尿。术后51．9％恢复勃起功能。结论耻骨后前列腺癌根治术是局限性前列腺癌的首选治疗方法,充分的术前准备和术后严密随访有利于提高生存率。     

耻骨后前列腺癌根治术减少并发症的探讨

目的：探讨耻骨后前列腺癌根治术保留耻骨前列腺韧带及耻骨直肠悬带等对术后并发症的影响。方法：对16例前列腺癌患者（平均年龄67岁，B期14例，C期2例）实施了耻骨后前列腺癌根治术，术中保留耻骨前列腺韧带及耻骨直肠悬带。结果：16例患者手术顺利，随访14年，无长期尿失禁及排尿困难，6例保留睾丸者术后4例恢复了性功能，9例患者PSA保持在0．05ng／ml，7例PSA〈0．05ng/ml，16例均存活。结论：耻骨后前列腺癌根治术中保留耻骨前列腺韧带及耻骨直肠悬带有助于减少并发症，取得较好的手术效果。     

腹腔镜前列腺癌根治术治疗早期前列腺癌对雄激素水平及术后尿失禁发生率的影响

目的　探究早期前列腺癌患者应用腹腔镜前列腺癌根治术治疗的雄激素水平及术后尿失禁发生率。方法　选取江南大学附属医院2020年10月至2022年10月收治的102例早期前列腺癌患者,随机数字表法分为常规组51例和观察组51例。观察组年龄（56.85±10.26）岁,常规组年龄（57.25±11.25）岁。常规组行开放性前列腺癌根治术治疗,观察组行腹腔镜前列腺癌根治术。比较2组患者手术相关指标,雄激素（游离睾酮及双氢睾酮）水平,术后尿失禁发生率。计量资料采用t检验,计数资料采用χ²检验。结果　观察组术中出血量低于常规组,观察组手术时间、术后拔管时间短于常规组（均P<0.05）。2组患者术前游离睾酮、双氢睾酮水平比较差异均无统计学意义（均P>0.05）;2组患者术后的游离睾酮、双氢睾酮较术前均降低,但观察组高于常规组（均P<0.05）。观察组患者的术后尿失禁发生率［5.88%（3/51）］低于常规组［19.61%（10/51）］（P<0.05）。结论　腹腔镜前列腺癌根治术治疗早期前列腺癌,有助于改善手术指标,提高雄激素水平,降低术后尿失禁发生率,值得推广。     

Outcomes of transrectal ultrasound scan of the prostate with sector biopsies for 323 New Zealand men with suspicion of prostate cancer

AIMS: To assess the results and clinical outcomes of the first four years of transrectal ultrasound scanning (TRUS) with sector biopsies of the prostate, as the definitive second-line investigation for men with suspicion of prostate cancer, including comparability with subsequent information from histology of surgical specimens. METHODS: Information was collated from the author's ongoing surgical audit. TRUS and sector biopsies were carried out as a rooms procedure using a Toshiba Sono-Layer SSA-270A ultrasound machine with a PVL 725 RT transrectal probe and biopsy guide. Six or eight sector biopsies were taken with a Manan biopsy gun using 18 French gauge biopsy needles. Prophylactic ciprofloxacin and tinidazole were administered. Men with suspicion of prostate-specific antigen assay or digital rectal examination were considered for the investigation, especially if they were candidates for potentially curative treatments. RESULTS: Of 330 TRUS procedures performed on 323 men, 328 were done in rooms under local anaesthetic. The only significant complication was a transient bacteraemia in one patient not taking the antibiotics. Twenty men had prostate intraepithelial neoplasia or atypia, and 94 (29%) had cancer, of whom 24 (25%) had evidence of metastases. Curative treatment by radical prostatectomy or radiotherapy was attempted in 62 men (66%) and 28 are being managed by surveillance only. Comparisons with subsequent radical prostatectomy in 44 men showed that if only one TRUS biopsy core was involved with cancer (15 men), surgical margins were clear. For those with more cores involved (29 men), one-third (9 men) had positive margins or capsular perforation. The Gleason Score was different, more often higher, for 29 men by histology at radical prostatectomy compared to TRUS. Twenty-eight men had a subsequent transurethral resection of the prostate of which the histology resulted in management changes for ten of the 28, including three who were placed on surveillance and seven who underwent radical prostatectomy. CONCLUSIONS: TRUS and sector biopsy is a tolerable rooms procedure for men with suspician of prostate cancer. Complications are rare if prophylactic antibiotics are taken. The procedure provides information of sufficient quality to advise patients further. No defects in specificity were detected. Defects in sensitivity were demonstrated by comparison with later histology following transurethral resection. Therefore, men with benign results at TRUS need ongoing follow-up. TRUS histology tends to underestimate the extent of cancer present as determined by subsequent radical prostatectomy histology. When used with prostate-specific antigen and digital rectal examination, TRUS and sector biopsy is capable of detecting prostate cancer before it has metastasized, more reliably than if symptoms are awaited before diagnosis is attempted. It may also recognize forms of cancer of apparent low clinical significance which can be managed by surveillance.     

PC-SPES for the treatment of prostate cancer?

A 73-year-old man recently attended his local USToo International prostate cancer support group and during the meeting several members were discussing using PC-SPES for treatment of their prostate cancer. The patient's history is significant for prostate cancer and as a result he had a radical prostatectomy. Two years ago, he relapsed with bone metastases and he was subsequently treated with combined anti-androgen therapy. Over the last 6 months his symptoms and prostate-specific antigen have increased, despite anti-androgen withdrawal and a regimen of cancer chemotherapy. The patient is aware that his prostate cancer is incurable, but he wants to know if PC-SPES can help.     

前列腺癌诊治分析(附41例报告)

目的 探讨前列腺癌的诊断及治疗方案,进一步提高前列腺癌诊治水平.方法 回顾分析41例前列腺癌的诊断及治疗情况.结果 PSA联合DRE和TRUS检查的诊断符合率为.TRUS引导下的前列腺穿刺活检诊断符合率为95.1%.Gleason评分≤6的4例,Gleason评分=7的4例,Gleason评分≥8的33例.6例行前列腺癌根治性切除术,35例晚期肿瘤行内分泌治疗.结论 大多数患者以尿路梗阻症状就诊,早期诊断的前列腺癌病例并不多,绝大多数都是中晚期病例.根治性前列腺切除术是早期前列腺癌首选治疗方法,内分泌治疗是晚期前列腺癌的首选治疗方法.     

Occupational risk factors for prostate cancer in an area of former coal,iron, and steel industries in Germany. Part 2: results from a study performed in the 1990s

ABSTRACT

Currently, there is no established occupational risk factor for prostate cancer. However, in the 1980s, a hospital-based case-control study in the greater Dortmund area showed an elevated risk for hard coal miners and, based on few cases, for painters and varnishers. Therefore, approximately 10 yr later, a similar study regarding prostate cancer was performed in this area. In total, 292 patients with prostate cancer who underwent radical prostatectomy and 313 controls who underwent transurethral resection of a benign prostatic hyperplasia were investigated by questionnaire. All of them were operated on between 1995 and 1999. This study showed a decreased risk for prostate cancer in hard coal miners (odds ratio [OR] = 0.67, 95% confidence interval [CI] = 0.44–1.03). Occupational exposures related to an elevated risk for prostate cancer were exposures to combustion products (20% cases vs. 11% controls), colorants and dyes (19 vs. 13%), and cutting fluids (8 vs. 6%). The different prostate cancer risks for underground coal miners in two studies with a time interval of approximately 10 yr are striking. Factors to be discussed are the introduction of prostate-specific antigen (PSA) screening for prostate cancer and investigation of cases that underwent radical prostatectomy, where the disease in general is locally confined. Working conditions in the local underground coal mines improved over time but did not change markedly in the period of interest. In essence, the present study does not corroborate an elevated prostate cancer risk in former underground hard coal miners from the greater Dortmund area.     

β2 微球蛋白在内分泌治疗前列腺癌根治术后患者体内表达与预后关系研究

目的观察β2微球蛋白在内分泌治疗前列腺癌根治术后患者体内表达情况及其与患者预后关系。方法选取我院行前列腺根治术联合内分泌治疗病例30例,术后3周服用氟他胺（250mg,3次/天）。分别在治疗前、治疗后3月、6月、12月收集患者血清,采用放射免疫法检测血清β2微球蛋白的表达。分析患者β2微球蛋白表达水平与患者Gleason评分以及PSA的关系。结果治疗后β2微球蛋白以及PSA水平均显著降低,差异有统计学意义（P〈0.05）。Pearson相关性分析显示,β2微球蛋白以及PSA水平有相关性（r1=0.693,r2=0.627,P〈0.05）,Gleason评分与β2微球蛋白以及PSA表达水平呈正相关（r=0.857,P〈0.05;r=0.793,P〈0.05）。结论血清β2微球蛋白是诊断以及检测肿瘤治疗预后的有效指标,与PSA协同观察可以提高临床诊断以及治疗水平。     

腹腔镜前列腺癌根治术不同入路的临床效果及对患者性功能的影响

目的探讨腹腔镜前列腺癌根治术不同入路的治疗效果及对患者性功能的影响。方法 60例行腹腔镜前列腺癌根治术治疗的患者,根据入路方式的不同分为观察组与对照组,各30例。对照组选择经腹腔入路腹腔镜前列腺癌根治术治疗,观察组选择经后腹膜入路腹腔镜前列腺癌根治术治疗。比较两组患者手术相关指标及手术前后国际勃起功能评分表(IIEF-5)评分。结果观察组手术时间(120.39±8.51)min、胃肠功能恢复时间(1.75±1.08)d、引流时间(3.24±1.37)d、尿管拔除时间(12.01±3.14)d、住院时间(14.36±3.25)d均短于对照组的(185.07±12.44)min、(3.56±1.42)d、(5.43±1.89)d、(16.95±3.47)d、(21.68±5.73)d,术中出血量(422.05±31.86)ml少于对照组的(618.37±50.69)ml,差异均有统计学意义(P<0.05)。术后6个月,两组的IIEF-5评分均较术前提高,且观察组高于对照组,差异均有统计学意义(P<0.05)。结论腹腔镜前列腺癌根治术在前列腺癌患者治疗中可发挥显著应用价值,且经后腹膜入路较经腹腔入路具有微创、术后恢复快等优势,更利于促进其性功能的改善。