经膀胱前入路和经膀胱后入路机器人辅助前列腺癌根治术早期效果比较

目的:探讨不同入路机器人辅助前列腺癌根治术的早期效果。方法:回顾性分析2018年3月至2020年3月北京协和医院泌尿外科同一术者完成的44例机器人辅助前列腺癌根治术的病例资料,患者平均年龄65.9岁（范围：46~81岁）。手术经膀胱前入路完成24例（前入路组）,经膀胱后入路完成20例（后入路组）。采用 t检...     

经腹膜外入路腹腔镜前列腺癌根治术(附16例报告)

目的总结经腹膜外入路腹腔镜前列腺癌根治术的临床体会。方法回顾性分析2010年10月至2011年12月,采用四孔经腹膜外入路行腹腔镜前列腺癌根治术治疗局限性前列腺癌患者16例的临床资料。结果本组16例手术全部顺利完成,9例同期行盆腔淋巴结清扫术,无一例中转开放。手术时间150～420min,平均270min。术中出血量50～2000ml,平均534ml,4例术中输血400～800ml,输血率25%。术后病理报告切缘阳性1例(6.2%)。术后4～15d出院,平均8d。所有患者留置尿管2周,拔除尿管后无真性尿失禁。随访3～17个月,8例昼夜控尿良好,8例白天偶有压力性尿失禁,其中1例术后4个月出现吻合口狭窄。9例患者术后可勃起,其中1例行保留神经的前列腺癌根治术患者术后1个月可正常进行性生活。结论经腹膜外入路腹腔镜前列腺癌根治术具有创伤小、出血少、操作容易、并发症少等优点,是开展腹腔镜前列腺癌根治术的较好选择。     

经腹腔与经腹膜外途径腹腔镜前列腺癌根治术疗效比较的Meta分析

目的:用Meta分析评价经腹腔入路腹腔镜前列腺癌根治术(TLRP)与经腹膜外入路腹腔镜前列腺癌根治术(ELRP)治疗局限性前列腺癌的疗效和安全性。方法:通过计算机检索Medline、Cochrane临床对照试验中心数据库、中国学术期刊全文数据库、万方数据库和中国生物医学文献数据库,按纳入和排除标准,两位研究员独立进行文献筛查、质量评价和数据提取,交叉核对,并用Stata12.0软件进行Meta分析评价手术时间、术中出血量、术后尿管留置天数、肠功能恢复时间、术后住院天数等相关指标。结果:共纳入9篇文献,共942例患者,其中行TLRP患者492例,行ELRP患者450例。Meta分析结果显示:TLRP与ELRP两者在手术时间[SMD=0.60,95%CI(-0.06,1.26)]、术中出血量[SMD=0.01,95%CI(-0.35,0.36)]、术后留置尿管时间[SMD=0.10,95%CI(-0.21,0.40)]、术后住院天数[SMD=0.45,95%CI(-0.01,0.91)]方面无统计学差异,在肠功能恢复时间[SMD=1.18,95%CI(0.26,2.10)]有显著性差异。结论:TLRP和ELRP在治疗局限性前列腺癌在手术时间、术中出血量、留置尿管时间、术后住院天数方面无统计学差异,在肠功能恢复时间上,ELRP比TLRP更具有优势。     

经腹腔入路腹腔镜前列腺癌根治术(附10例报告)

目的探讨经腹腔入路腹腔镜前列腺癌根治术的临床疗效。方法 2006年7月至2010年11月,采用五孔经腹腔入路对10例T1、T2期前列腺癌进行根治性切除,其中T1期1例,T2期9例,平均年龄67岁。结果平均手术时间186min,平均出血量约150ml,1例中转开放。均未输血,无并发症发生。随访2～52个月,所有患者排尿通畅,8例昼夜排尿完全控尿,2例夜间有轻微遗尿。无局部及远处转移。结论经腹腔入路腹腔镜前列腺癌根治术具有创伤小、出血少、操作容易、并发症少等优点,是初开展腹腔镜前列腺癌根治术的较好选择。     

3种机器人辅助腹腔镜根治性前列腺切除术手术入路对比研究:前入路、后入路及经膀胱入路

目的:比较前入路、后入路及经膀胱入路机器人辅助腹腔镜根治性前列腺切除术(RARP)围手术期指标及手术效果。方法:回顾性分析2015年12月～2018年8月收治的43例前入路RARP(前入路组)、26例后入路RARP(后入路组)和10例经膀胱入路RARP(经膀胱入路组)患者的临床资料。比较三组患者临床资料、围手术期指标(手术时间、术中出血、术后病理分期、术后Gleason评分、切缘阳性率)及手术效果[尿控恢复时间、术后国际勃起功能问卷表-5(IIEF-5)]。结果:前入路组平均年龄(69.7±7.3)岁,平均BMI(22.9±3.1)kg/m~2,平均术前tPSA(34.5±21.3)ng/ml,术前Gleason评分中位值8(6～9)分,平均前列腺体积(38.2±16.6)ml,术前IIEF-5评分中位值12(6～19)分。后入路组平均年龄(62.3±10.9)岁,平均BMI(27.2±6.3)kg/m~2,平均术前tPSA(15.8±7.2)ng/ml,术前Gleason评分中位值7(6～8)分,平均前列腺体积(44.7±10.8)ml,IIEF-5评分中位值13(6～20)分。经膀胱入路组平均年龄(58.6±9.4)岁,平均BMI(26.5±3.1)kg/m~2,平均术前tPSA(19.5±4.1)ng/ml,术前Gleason评分中位值6(6～7)分,平均前列腺体积(33.4±15.8)ml,术前IIEF-5评分中位值16(10～21)分。临床分期前入路组:cT_(1c)期18例,cT_(2a)期3例,cT_(2b)期3例,cT_(2c)期17例,cT_(3a)期1例,cT_(3b)期1例;后入路组:cT_(1c)期17例,cT_(2a)期3例,cT_(2b)期4例,cT_(2c)期2例;经膀胱入路组:cT_(1c)期8例,cT_(2a)期1例,cT_(2b)期1例。所有患者术前尿控均正常。79例手术均顺利完成,无中转开放病例,无输血病例,无严重术中、术后并发症发生。术后病理结合术前检查示前入路组:pT_(2b)期9例,pT_(2c)期16例,pT_(3a)期3例,pT_(3b)期12例,pT_4期3例,Gleason评分中位值8(6～9)分;后入路组:pT_(2a)期13例,pT_(2b)期9例,pT_(2c)期2例,pT_(3a)期2例,Gleason评分中位值7(6～8)分;经膀胱入路组:pT_(2a)期6例,pT_(2b)期3例,pT_(2c)期1例,Gleason评分中位值6(6～7)分。前入路组切缘阳性11例(25.6%),后入路组切缘阳性6例(23.1%),经膀胱入路组切缘阳性1例(20.0%),三组比较差异无统计学意义(P0.05)。前入路组手术时间(115.5±20.5)min,后入路组手术时间(126.5±33.5)min,经膀胱入路组手术时间(140.5±15.5)min。前入路组术中失血量(80±20.5)ml,后入路组术中失血量(44.5±9.5)ml,经膀胱入路组术中失血量(65.5±35.5)ml。前入路组术后3周拔除尿管,其余两组患者术后7d拔除导尿管,前入路组完全恢复尿控时间(6.5±3.5)周,后入路组22例即刻实现尿控(尿控定义为无需使用尿垫),4例术后2周实现尿控;经膀胱入路组患者9例即刻实现尿控,1例术后2周实现尿控;后入路组与经膀胱入路组比较差异无统计学意义(P0.05),前入路组与后入路组、前入路组与经膀胱入路组比较差异均有统计学意义(P0.05)。三组患者随访时间3～35个月,平均12个月,所有患者尚无肿瘤复发表现(tPSA0.2ng/ml)。术后第3个月,IIEF-5评分中位值前入路组为10(4～12)分,后入路组为10(4～13)分,经膀胱入路组为11(5～14)分,三组比较差异无统计学意义(P0.05);三组IIEF-5评分与术前比较差异均无统计学意义(P0.05)。结论:经膀胱入路RARP有待成为治疗局限性低风险前列腺癌的可选术式。经膀胱入路与后入路患者术后即刻尿控率较高,均优于前入路,术后肿瘤控制效果和勃起功能仍有待于进一步随访。     

经腹腔与经腹膜外入路腹腔镜前列腺癌根治术疗效分析

目的比较经腹腔与经腹膜外入路腹腔镜前列腺癌根治术的疗效。方法随机将52例行腹腔镜前列腺癌根治术的前列腺癌患者分为2组,各26例。对照组经腹腔入路,观察组经腹膜外入路。结果 2组均成功完成腹腔镜手术。观察组手术时间及术后尿管留置时间、胃肠功能恢复时间和住院时间均短于对照组,差异均有统计学意义(P0.05)。2组术中出血量及术后并发症发生率差异无统计学意义(P0.05)。术后随访12个月,2组生化复发率及控尿率差异无统计学意义(P005)。结论经腹腔与经腹膜外腹腔镜前列腺癌根治术治疗前列腺癌,均有满意效果且安全性高。但经腹膜外入路具有手术时间短、术后恢复快等优点。但学习曲线时间较长,对医生的临床经验及腹腔镜手术操作技巧要求较高。     

机器人单孔经膀胱入路前列腺癌根治术的护理配合

目的:总结机器人辅助单孔经膀胱入路前列腺癌根治术的手术护理配合经验。方法:选择7例行机器人辅助单孔经膀胱前列腺癌根治术的患者,对术前准备、术中配合和术后整理经验进行总结。结果:7例患者的手术均在全机器人辅助腹腔镜下完成,无中转开放,平均手术时间为2.5h,术中平均出血量为50ml,平均住院天数为5d。术后未放置腹腔引流管,无护理相关并发症,所有患者拔管后尿控良好。医护人员做到有效沟通、团队协作,将优质护理贯穿于整个围术期;洗手护士、巡回护士分工合作,保障了手术患者的安全。结论:对行机器人辅助单孔经膀胱入路前列腺癌根治术的患者进行的手术期护理可以提高手术效率,降低手术风险,缩短患者住院时间,值得进一步推广。     

机器人辅助完全后入路筋膜内前列腺癌根治术5例经验总结

目的简要介绍机器人辅助完全后入路筋膜内前列腺癌根治术的初步经验。方法回顾性分析浙江大学医学院附属邵逸夫医院泌尿外科2016年8月至10月间5例机器人辅助完全后入路筋膜内前列腺癌根治术患者的临床资料。结果所有手术均顺利完成,手术时间为124~155分钟,平均(139.8±13.9)分钟;术中出血量30~80ml,平均(52.0±19.2)ml。无切缘阳性患者。术后6周复查PSA均达到根治标准。3例患者术后拔除导尿管后即能完全控尿,未使用尿垫,其余2例在术后1个月内控尿完全恢复。2例患者术后1个月内恢复勃起功能,其余3例随访1个月未见明显性功能恢复。结论机器人辅助完全后入路筋膜内前列腺癌根治术是可行的。患者的肿瘤控制、术后尿控以及性功能恢复均较为满意。有条件的单位可选择合适患者施行。     

侧方精囊入路保留完整膀胱颈口前列腺癌根治术患者即刻尿控临床效果

目的:探讨改良腹腔镜下侧方精囊入路保留完整膀胱颈口技术在根治性前列腺切除术中的早期尿控恢复的临床效果。方法:前瞻性纳入2021年6月—2022年12月温岭市中医院收治的T₁～T_3b期100例前列腺癌患者,分为传统组(A组)及保留膀胱颈口组(B组)。记录保留膀胱颈完整性及成功率、膀胱尿道吻合时间、拔除导尿管时间、住院时间;观察拔除导尿管后1周、1个月、3个月时尿控评分和尿垫情况,并观察不良事件情况等。采用t检验、χ²检验和Fisher确切概率法比较2组患者的术前临床资料、围手术期相关结果及术后尿控情况。结果:2组患者的年龄、前列腺重量、术前前列腺特异性抗原(PSA)及Gleason评分均差异无统计学意义(P>0.05)。2组患者的手术时间、术中出血量、病理学分期、切缘阳性率均差异无统计学意义(P>0.05)。A组拔除导尿管后1周、1个月、3个月尿失禁问卷国际咨询-尿失禁(ICIQ-UI)评分为15(14,16)、13(13,15)、6(5,11)分,B组为5(1,12)、1.5(0,9)、0(0,0)分,差异有...     

改良经腹腔途径腹腔镜下前列腺癌根治术的临床研究

目的 评价改良的经腹腔途径腹腔镜下前列腺癌根治术的手术技术及其临床效果.方法 回顾性分析2008年1月至2010年6月行经腹腔途径腹腔镜下前列腺癌根治术的105例患者资料.患者年龄51～73岁,术前血清特异前列腺抗原平均13.6μg/L,前列腺体积平均45 ml,术前均由病理检查确诊,Gleason评分6～8分,核素骨扫描示无骨转移.经腹腔途径腹腔镜下前列腺癌根治术中对膀胱颈精囊腺分离以及膀胱颈后尿道吻合等技术进行了改良.结果 手术时间65～150 min,半均93 min.术中出血50～400 ml,平均115 ml,术中均未中转开放手术,无大血管及直肠损伤.术后切缘阳性24例,术后吻合口尿漏1例,无肠道并发症.术后平均7 d拔除尿管,拔管后正常尿控64例,术后3个月内恢复尿控33例,术后3～12个月内恢复尿控5例.术后随访5～33个月,平均16个月.随访期间有3例尿失禁,保留性神经患者中15例术后勃起功能良好,17例出现生化复发.结论 经腹腔途径腹腔镜下前列腺痛根治术手术操作空间大,解剖标志清晰,肿瘤治疗效果满意.对膀胱颈分离及后尿道吻合等技术的改进可明显缩短手术时间,提高手术效率,减少手术并发症.

Abstract：

Objective To evaluate the technique and clinical outcomes of modified transperitoneal laparoscopic radical prostatectomy. Methods A total of 105 patients received the operation with age ranging from 51 to 73 years from January 2008 to June 2010. Mean level of serum prostate specific antigen was 13. 6 μg/L and mean prostatic volume was 45 ml. Pathological studies of biopsy confirmed the prostate carcinoma with Gleason score 6-8. Radionuclide bone scan revealed no metastasis. Based on previously retroperitoneal radical prostatectomy, modified technique was applied involving surgical approach, bladder neck dissection and vesicourethral anastomosis. Results Mean operative time was 93 min (65-150 min).Intraoperative blood loss was 115 ml (50-400 ml). No complication of bowl injury occurred. Positive surgical margin was present in 24 patients. Normal continence were seen in 64 patients after catheter removed. Recovery of incontinence within 3 months was seen in 33 patients and 3 to 12 months in 5 patients respectively. Three patients with incontinence were still in the follow-up. Conclusions Transperitoneal laparoscopic radical prostatectomy provides large working space and clear anatomic exposure. Higher efficiency and lower complication rate are obtained through modified laparoscopic technique involving seminal vesicle isolation, bladder neck dissection and vesicourethral anastomosis.     

经腹膜外途径腹腔镜下前列腺癌根治术

目的 探讨经腹膜外途径腹腔镜下前列腺癌根治术的临床效果及安全性. 方法 临床局限性前列腺癌患者15例,均行经腹膜外途径腹腔镜下前列腺癌根治术.术前平均总PSA 8.1ng/ml,平均Gleason评分5.7±1.3.采用切开腹白线的"北京医院建立腹膜外操作间隙技术"建立腹膜外间隙.手术过程中分离,切割和止血均采用超声刀技术.记录患者手术时间,估计术中出血量、术中并发症、留置引流管时间、术后疼痛指数、术后住院时间、术后病理和PSA等临床资料,并对结果进行分析. 结果 15例手术14例腹腔镜完成,1例因吻合困难中转开放手术.手术时间(316±74)min;术中估计出血量(408±362)ml.5例(33%)患者接受了输血,无直肠及输尿管损伤.术后第1和2天疼痛指数分别为2.3和1.4分.术后留置导尿(14.1±2.9)d,平均住院时间(19.5±4.9)d.术后Gleason评分5.7±1.8.标本切缘阳性2例(13%).病理检查未发现淋巴结转移病例.随访1～12个月,完全控尿10例(67%),PSA<0.2 ng/ml 12例.结论 经腹膜外途径腹腔镜下前列腺癌根治术是一种安全可行的局限性前列腺癌的手术方式.     

Retrospective comparative study of 59 cases of laparoscopic radical prostatectomy: Transperitoneal anterior versus transperitoneal posterior approach

OBJECTIVE: We retrospectively compared perioperative parameters, as well as the oncological and functional results, for laparoscopic radical prostatectomy (LRP) carried out via the posterior and anterior approaches in our hospital. METHODS: We recorded pre-, peri-, and postoperative parameters and complications, and evaluated the oncological and functional results to compare the posterior approach (group 1, n = 25) with the anterior approach (group 2, n = 34). RESULTS: There were no significant differences regarding the preoperative characteristics of the two groups. The incidence of major complications, positive surgical margins, and continence at 3 and 6 months postoperatively showed no significant differences between the two groups. Although mean blood loss (including urine) was not significantly different, the mean prostatectomy time was significantly shorter in group 2 (174.21 +/- 57.97 min) than in group 1 (224.76 +/- 66.72 min) (P = 0.003 by Student's t-test). Also, the postoperative recovery period until discharge was 5.94 days in group 2, and was significantly shorter than in group 1 (7.48 days) (P = 0.02 by Student's t-test). CONCLUSIONS: This retrospective comparative study shows that the anterior approach yields similar, if not better results than the posterior approach for LRP.     

腹膜外径路腹腔镜前列腺癌根治术(附12例报告)

目的探讨腹膜外途径腹腔镜前列腺癌根治术的临床效果。方法回顾性分析总结2009年5月至2011年7月经腹膜外径路进行腹腔镜前列腺癌根治术患者12例,年龄60～75岁,平均年龄68岁。血清前列腺特异性抗原(prostate specific antigen,PSA)为0.7～23.6ng/ml。TNM分期T1N0M08例,T2N0M03例,T3aN0M01例。所有患者均于术前行前列腺穿刺活组织检查,证实为前列腺癌。结果 12例患者均顺利完成手术,手术时间为130～360min,平均270min;术中出血量为150～900ml,平均390ml,1例患者术中输血。术后病理检查结果显示肿瘤切缘为阳性的2例患者术后加用全雄激素阻断治疗3个月。术后留置尿管时间14～22d,平均18.6d,无直肠损失病例,3例术后出现轻度尿失禁的患者经提肛训练等辅助治疗3个月后好转,能自主排尿。术后3个月时PSA为0.02～0.10ng/ml,术后随访8例,随访时间为3～24个月,未发现肿瘤局部复发和远处转移。结论腹膜外径路腹腔镜前列腺癌根治术视野清晰、创伤小、恢复快,是一种安全、有效的治疗方法,值得临床推广。     

提高腹腔镜前列腺癌根治术后控尿的临床研究

目的 分析总结腹腔镜前列腺癌根治术51例手术控尿技术的经验.方法 回顾性总结腹腔镜前列腺癌根治术患者51例.术前均病理证实前列腺癌诊断.T la～1b 4例(8%),T 1c 15例(29%),T2a 7例(14%),T2b 5例(10%),T2c 20例(39%).结果 腹腔镜下成功完成前列腺癌根治术49例.术后发生尿漏3例,均自愈.术后尿管留置14～45 d,平均16 d.术后随访3～53个月,平均17个月.术后3个月随访51例患者,13例尿失禁;术后6个月随访39例患者,7例尿失禁;术后12个月随访患者20例,5例尿失禁,其中完全性尿失禁1例.前20例和后31例在术后3个月时尿失禁发生率分别为6/20(30%)和7/31(22%),差异有统计学意义(P<0.05).直肠损伤2例,行结肠造口术.术后复发2例,一例行内分泌治疗后停药.另一例肺转移手术后死亡.其余病例前列腺特异抗原<0.2μL.结论 腹腔镜前列腺癌根治术治疗局限性前列腺癌是安全、有效的.术后控尿功能主要与术中前列腺尖部、耻骨前列腺韧带和神经血管束的处理及手术经验相关.     

经腹膜外腹腔镜下前列腺癌根治术

目的 探讨腹膜外腹腔镜下前列腺癌根治术的手术方法和疗效. 方法 2003年2月至2008年6月对91例前列腺癌患者行腹膜外腹腔镜下前列腺癌根治术,患者均经病理检查确诊,Gleason评分≤8分,盆腔CT、MR和核素全身骨扫描示无盆腔淋巴结、精囊和骨转移,手术经腹膜外顺行径路切除前列腺,标本自脐下切口处取出.术中行盆腔淋巴结活检32例,行保留性神经前列腺癌根治11例. 结果 平均手术时间173(105～270)min,平均出血量315(110～1200)ml.术中直肠损伤2例,术后病理检查切缘阳性11例.术后出现不同程度尿失禁19例.其中术后3个月内恢复尿控18例,真性尿失禁1例.32例行盆腔淋巴结活检者均未发现阳性淋巴结,11例保留性神经患者中术后随访勃起功能良好5例.87例随访3～30个月,无尿道狭窄,术后28个月出现生化复发3例.结论腹膜外腹腔镜下前列腺癌根治术安全有效,手术创伤小、恢复快,与开放前列腺癌根治术效果相近.     

经会阴前列腺癌根治术28例报告

目的 探讨经会阴前列腺癌根治术在早期局限性前列腺癌治疗中的应用价值。方法 总结28例临床分期T1a～T2b前列腺癌患者经会阴前列腺癌根治术临床资料。经直肠B超引导下前列腺穿刺活检，证实为前列腺腺癌，Gleason评分2～4分13例，5～7分15例。血清PSA2．3～16．6ng／ml，平均9．2ng／ml。术前CT或MRI检查确定前列腺癌局限于前列腺包膜内，胸部、脊椎与骨盆X线平片、ECT均未发现远处转移灶。临床分期T1a～Tb3例，T1a5例，T213例，T2b7例。结合血清PSA、临床分期和GMason评分预测临床早期前列腺癌的病理分期均在T2内，28例均行经会阴前列腺癌根治术，未行盆腔淋巴结切除。结果 术后保留导尿5d，拔除导尿管后，23例患者控尿良好，4例患者有3～7d短暂的尿失禁。发生尿道直肠瘘1例，术后2个月瘘道自行愈合。术后病理：肿瘤局限于前列腺包膜内27例，有单侧包膜外浸润（T3a）1例。28例术后随访6～30个月。术后3个月PSA〈0．04ng／ml24例，1例〈0．01ng／ml，2例未检测到PSA。1例切缘阳性（T3a）、术后PSA持续升高者，行双侧睾丸切除。术后6个月20例同时复查胸部X线片和全身骨扫描，未发现远处转移病灶。结论 经会阴前列腺癌根治术治疗早期局限性前列腺癌在肿瘤控制和排尿控制方面有突出优势，结合PSA、临床分期和Gleason评分选择的病例，不需行盆腔淋巴结切除。     

改良经腹腔途径腹腔镜下前列腺癌根治术的临床研究

Objective To evaluate the technique and clinical outcomes of modified transperitoneal laparoscopic radical prostatectomy. Methods A total of 105 patients received the operation with age ranging from 51 to 73 years from January 2008 to June 2010. Mean level of serum prostate specific antigen was 13. 6 μg/L and mean prostatic volume was 45 ml. Pathological studies of biopsy confirmed the prostate carcinoma with Gleason score 6-8. Radionuclide bone scan revealed no metastasis. Based on previously retroperitoneal radical prostatectomy, modified technique was applied involving surgical approach, bladder neck dissection and vesicourethral anastomosis. Results Mean operative time was 93 min (65-150 min).Intraoperative blood loss was 115 ml (50-400 ml). No complication of bowl injury occurred. Positive surgical margin was present in 24 patients. Normal continence were seen in 64 patients after catheter removed. Recovery of incontinence within 3 months was seen in 33 patients and 3 to 12 months in 5 patients respectively. Three patients with incontinence were still in the follow-up. Conclusions Transperitoneal laparoscopic radical prostatectomy provides large working space and clear anatomic exposure. Higher efficiency and lower complication rate are obtained through modified laparoscopic technique involving seminal vesicle isolation, bladder neck dissection and vesicourethral anastomosis.     

改良经腹腔途径腹腔镜下前列腺癌根治术的临床研究

Objective To evaluate the technique and clinical outcomes of modified transperitoneal laparoscopic radical prostatectomy. Methods A total of 105 patients received the operation with age ranging from 51 to 73 years from January 2008 to June 2010. Mean level of serum prostate specific antigen was 13. 6 μg/L and mean prostatic volume was 45 ml. Pathological studies of biopsy confirmed the prostate carcinoma with Gleason score 6-8. Radionuclide bone scan revealed no metastasis. Based on previously retroperitoneal radical prostatectomy, modified technique was applied involving surgical approach, bladder neck dissection and vesicourethral anastomosis. Results Mean operative time was 93 min (65-150 min).Intraoperative blood loss was 115 ml (50-400 ml). No complication of bowl injury occurred. Positive surgical margin was present in 24 patients. Normal continence were seen in 64 patients after catheter removed. Recovery of incontinence within 3 months was seen in 33 patients and 3 to 12 months in 5 patients respectively. Three patients with incontinence were still in the follow-up. Conclusions Transperitoneal laparoscopic radical prostatectomy provides large working space and clear anatomic exposure. Higher efficiency and lower complication rate are obtained through modified laparoscopic technique involving seminal vesicle isolation, bladder neck dissection and vesicourethral anastomosis.     

改良经腹腔途径腹腔镜下前列腺癌根治术的临床研究

Objective To evaluate the technique and clinical outcomes of modified transperitoneal laparoscopic radical prostatectomy. Methods A total of 105 patients received the operation with age ranging from 51 to 73 years from January 2008 to June 2010. Mean level of serum prostate specific antigen was 13. 6 μg/L and mean prostatic volume was 45 ml. Pathological studies of biopsy confirmed the prostate carcinoma with Gleason score 6-8. Radionuclide bone scan revealed no metastasis. Based on previously retroperitoneal radical prostatectomy, modified technique was applied involving surgical approach, bladder neck dissection and vesicourethral anastomosis. Results Mean operative time was 93 min (65-150 min).Intraoperative blood loss was 115 ml (50-400 ml). No complication of bowl injury occurred. Positive surgical margin was present in 24 patients. Normal continence were seen in 64 patients after catheter removed. Recovery of incontinence within 3 months was seen in 33 patients and 3 to 12 months in 5 patients respectively. Three patients with incontinence were still in the follow-up. Conclusions Transperitoneal laparoscopic radical prostatectomy provides large working space and clear anatomic exposure. Higher efficiency and lower complication rate are obtained through modified laparoscopic technique involving seminal vesicle isolation, bladder neck dissection and vesicourethral anastomosis.