经腹膜外途径腹腔镜前列腺癌根治术(附5例报告)

目的:探讨经腹膜外途径腹腔镜前列腺癌根治术的临床体会。方法:采用经腹膜外途径对5例确诊为局限性前列腺癌的患者施行腹腔镜前列腺癌根治术,手术切除前列腺、精囊、输精管的壶腹以及膀胱颈的一部分,后行膀胱尿道吻合。结果:5例手术均获得成功,手术时间270~420 m in,平均350 m in,术中出血量250~600 m l,平均480 m l,术后48 h内胃肠功能恢复,术后2~3 d下床活动,术后住院7~12 d,平均8.5 d。术后随访3~8个月,无尿失禁,3例术前性功能正常的患者,2例术后可有满意的性生活。1例出现膀胱尿道吻合口狭窄,定期尿道扩张,排尿通畅。结论:经腹膜外途径腹腔镜前列腺癌根治术创伤小、对肠道无干扰、患者术后恢复快,可以成为治疗局限性前列腺癌的较好方法。     

经腹膜外腹腔镜前列腺癌根治术的关键点及操作技巧（附33例报告）

目的：总结经腹膜外腹腔镜前列腺癌根治术治疗前列腺癌的手术经验和操作技巧.方法：2006年1月～2010年3月对33例前列腺癌患者行经腹膜外腹腔镜前列腺癌根治术,手术经腹膜外顺行路径切除前列腺,切开膀胱颈部前先以1-0可吸收线缝扎背血管复合体,采用单针连续吻合法进行膀胱与尿道的吻合.结果：33例手术均获得成功,无中转开放手术.手术时间120～575 min,平均234 min,术中出血量100～1500 ml,平均320 ml,术后48小时内胃肠功能恢复,术后1～2天下地活动,没有直肠损伤和吻合口尿漏出现.标本切缘阳性1例.2例术后出现轻度尿失禁.2例出现尿道狭窄.对其中31例患者随访3～51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0～0.1 μg/L.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.熟悉前列腺局部解剖及熟练掌握各种腹腔镜下操作技术是手术成功的关键.     

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。     

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。     

3D腹腔镜与2D腹腔镜前列腺癌根治术的对比研究

目的 总结3D腹腔镜下前列腺癌根治术的手术方法,比较3D腹腔镜与2D腹腔镜下前列腺癌根治术的疗效。方法 回顾性分析2012年3月至2014年2月,我院66例行腹腔镜下前列腺癌根治术患者的临床资料,其中3D腹腔镜组43例,2D腹腔镜组23例,对比两种术式在手术时间、术中出血量、术后平均住院时间、术后尿失禁比例及保留勃起功能成功率等指标的差异。结果66例前列腺癌根治术均在腹腔镜下完成。3D腹腔镜组手术时间为65~125min,平均95min;术中出血30~150ml,平均60ml;术后平均住院时间为8d;术后轻度尿失禁7例（16.28%）;术中保留性神经27例,保留勃起功能成功率为37.04%。2D腹腔镜组手术时间为74~146min,平均112min;术中出血66~196ml,平均110ml;术后平均住院时间为8.5d;术后轻度尿失禁5例（21.74%）;术中保留性神经11例,保留勃起功能成功率为27.27%。66例术后病理均证实为前列腺癌,Gleason评分4~9分,无切缘阳性。术后随访2~23个月,5例生化复发。结论 与2D腹腔镜比较,在高清3D立体视野下完成的3D腹腔镜下前列腺癌根治术,解剖层次更加清晰,分离更为精细,缝合更为精确。     

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。     

单孔腹腔镜前列腺癌根治术：附5例报告

目的报道经脐部单孔多通道腹腔镜前列腺癌根治术手术的初步经验。方法 2010年6月至2010年11月,对5例TNM分期为T1b～T2的前列腺癌患者行经腹途径单孔腹腔镜前列腺癌根治术,所有患者既往无盆腔手术史。经脐部切口,长约4cm,置入单孔多通道设备（Quadport）,在此切口之外无附加任何其他操作通道。结果 5例手术均获得成功,无一例中转开放或传统腹腔镜手术。手术时间185～370min,平均303min。术中出血量220～650ml,平均431ml,无一例患者需输血。术后留置尿管时间12～21d,平均17d。无直肠损伤等并发症。术后住院时间12～25d,平均19d。所有病例术后病理均报告前列腺包膜完整,肿瘤切缘均为阴性。所有5例患者术后随访2～15周,控尿恢复良好,每天使用尿片约0～2片。结论单孔腹腔镜前列腺癌根治术是安全有效的治疗方法。     

前列腺癌根治术后的腹腔镜腹股沟疝修补术

目的:探讨前列腺癌根治术后病人腹腔镜腹股沟疝修补术临床应用的安全性、可行性及有效性。方法 :收集我院2013年1月至2015年10月经耻骨后前列腺癌根治术后行腹腔镜腹股沟疝修补术20例,分析手术情况及术后恢复情况。结果:20例均顺利完成腹腔镜腹股沟疝修补术,无手术并发症发生及中转。平均手术时间单侧(55±18)min,双侧(82±25)min。术后中位住院天数2(2~5)d。术后有1例出现血清肿,穿刺后消失。术后随访中位时间12(1~21)个月,无复发。结论:腹腔镜腹股沟疝修补术在前列腺癌根治术后病人中应用安全有效。经耻骨后前列腺癌根治术后不是腹腔镜腹股沟疝修补术的禁忌证。     

3D与2D腹腔镜下前列腺癌根治术的临床疗效比较研究

目的:比较3D腹腔镜与2D腹腔镜下腹膜外途径前列腺癌根治术的临床疗效。方法:回顾性分析2012年2月~2016年6月共114例行腹腔镜下前列腺癌根治术患者的临床资料,所有手术均由同一术者主刀完成,其中2D腹腔镜组53例,3D腹腔镜组61例。对比两组的手术时间、尿道重建时间、术中出血量、术后尿失禁、术中保留性神经、手术切缘阳性率、术后随访时间和术后生化复发率等指标。结果:114例前列腺癌根治术均在腹腔镜下完成,无中转开放;2D腹腔镜组手术时间为60~190min,平均128.9min;尿道吻合时间10~30min,平均23.1min;术中出血10~1 500ml,平均110.4ml;术后1个月尿失禁15例(28.3%)、术后3个月尿失禁4例(7.4%);术中保留性神经9例(17%);PT2切缘阳性2例(阳性率8.3%);术后随访4~36个月,平均20.7个月;4例患者生化复发。其中3D腹腔镜组手术时间为40~180min,平均99.2min;尿道吻合时间10~28min,平均20.5min;术中出血10~800 ml,平均86.6 ml;术后1个月尿失禁14例(22.9%)、术后3个月尿失禁3例(4.9%);术中保留性神经11例(18%);PT2切缘阳性2例(阳性率5.4%);术后随访4~33个月,平均20.8个月;生化复发2例。114例术后病理均证实为前列腺癌,Gleason评分5~9分。结论:与2D腹腔镜相比,3D腹腔镜下腹膜外途径前列腺癌根治术手术时间短,尿道重建更精准快捷,术中出血少,术后并发症少,安全性更高。     

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。     

A direct comparison of robotic assisted versus pure laparoscopic radical prostatectomy: a single institution experience

PURPOSE: We compared a single institution experience with radical prostatectomy using a pure laparoscopic technique vs a robotically assisted technique with regard to preoperative, intraoperative or postoperative parameters. MATERIALS AND METHODS: From May 2003 to May 2005 we reviewed 133 consecutive patients who underwent extraperitoneal robot assisted radical prostatectomy and compared them to 133 match-paired patients treated with a pure extraperitoneal laparoscopic approach. The patients were matched for age, body mass index, previous abdominopelvic surgery, American Society of Anesthesiologists score, prostate specific antigen, pathological stage and Gleason score. Preoperative, perioperative and postoperative data, including complications and oncological results, were analyzed between the 2 groups. RESULTS: The 2 groups were statistically similar with respect to age, body mass index, prostate specific antigen, Gleason score and clinical stage. No statistical differences were observed regarding operative time, estimated blood loss, hospital stay or bladder catheterization between the 2 groups. The transfusion rate was 3% and 9.8% for laparoscopic radical prostatectomy and robotic assisted laparoscopic prostatectomy, respectively (p = 0.03). Conversion from robotic assisted laparoscopic prostatectomy to laparoscopic radical prostatectomy was necessary in 4 cases. None of the laparoscopic radical prostatectomy cases required conversion to an open technique. The percentage of major complications was 6.0% vs 6.8%, respectively (p = 0.80). The overall positive margin rate was 15.8% vs 19.5% for laparoscopic radical prostatectomy and robotic assisted laparoscopic prostatectomy, respectively (p = 0.43). CONCLUSIONS: We demonstrated that the laparoscopic extraperitoneal radical prostatectomy is equivalent to the robotic assisted laparoscopic prostatectomy in the hands of skilled laparoscopic urological surgeons at our institution with respect to operative time, operative blood loss, hospital stay, length of bladder catheterization and positive margin rate.     

Laparoscopic radical prostatectomy: technical and early oncological assessment of 40 operations.

OBJECTIVE: To evaluate the technical feasibility, oncological efficacy and intraoperative and postoperative morbidity of laparoscopic radical prostatectomy. METHOD: We describe an original technique of laparoscopic radical prostatectomy performed in 40 patients between 26th January and 12th October, 1998. RESULTS: Radical prostatectomy was performed entirely by laparoscopy in 35 patients (87.5%) and only one conversion was performed in the last 26 patients (4%). Pelvic lymphadenectomy was performed in the light of preoperative staging data in 14 patients (35%). The median total operating time was 270 min. The only major complication was a rectal injury (patient 8), sutured laparoscopically with an uneventful postoperative course. Postoperative vesical catheterization lasted an average of 7.65 days. Seven patients were transfused (17.5%) with an average of 2.8 units of packed cells (range: 2-3). The reduction of postoperative pain is an element allowing for a rapid discharge of the patients by the 3rd postoperative day. The oncological results were as follows: 36 patients had a pT2 tumor (90%); prostate tumor was staged as N0 in 14 cases and NX in 26 cases. Surgical margins were negative in 33 patients (82.5%). Two patients had a doubtful resection margin (1 at the apex and 1 at the bladder neck) and 5 patients had positive margins. The last PSA level was undetectable (<0.1 ng/ml) in 26 (89.7%) of the 29 patients in whom PSA level was available more than 1 month after the operation. Functional results are not yet available and will be published later. CONCLUSIONS: Radical prostatectomy is an operation which can be routinely performed by laparoscopy by a team experienced with this technique. Operative and postoperative morbidity was low. Short-term oncological data appear identical to the results of conventional retropubic surgery. The improvement of operative visibility was considerable allowing a much more precise dissection. The laparoscopic approach appears to represent a technical improvement of the radical prostatectomy if the functional results of this operation improve parallel to the quality of dissection. A long-term follow-up is needed to define definitively the place of this new approach to radical prostatectomy.     

Laparoscopic and robot assisted radical prostatectomy: establishment of a structured program and preliminary analysis of outcomes

PURPOSE: The technique of laparoscopic radical prostatectomy is difficult to master and is associated with a steep learning curve. We hypothesized that a structured approach to establishing a laparoscopic prostatectomy program would diminish complications during the learning process and that robotic technology would be useful in learning the operation. MATERIALS AND METHODS: A structured laparoscopic radical prostatectomy program was introduced at the Vattikuti Urology Institute on October 23, 2000. One of 2 surgeons with a combined experience of more than 500 laparoscopic radical prostatectomies performed or supervised the first prostatectomies, training a third surgeon with extensive "open" surgical skills but no laparoscopic experience. The "trained" surgeon then started performing the operation independently with robotic assistance. The results of this approach were analyzed at the end of 12 months. RESULTS: We performed 48 laparoscopic radical prostatectomies and 50 robot assisted prostatectomies within the 12-month period. The preoperative and intraoperative demographical variables were comparable in both groups as were the operative times, changes in hemoglobin concentrations, durations of hospitalization, positive margin rates and overall complication rates. All measured parameters were comparable to the "best-in-class" values for laparoscopic radical prostatectomy reported in the literature. CONCLUSIONS: A structured approach minimizes complications during the establishment of laparoscopic radical prostatectomy program. Robotic assistance helps skilled "open" surgeons learn the technique of laparoscopic radical prostatectomy.     

经腹与经腹膜外腹腔镜下前列腺癌根治术的效果比较

目的 比较经腹与经腹膜外途径腹腔镜下手术治疗前列腺癌的临床效果.方法前列腺癌患者33例行腹腔镜下前列腺癌根治术,其中经腹21例,经腹膜外12例.对2组患者手术时间、术中出血量、术中并发症、肠功能恢复时间、术后住院时间、术后并发症等资料进行比较分析.结果 33例手术均成功.经腹与经腹膜外2组手术时间分别为(299±46)和(309±64)min,出血量分别为(618±448)和(677±469)ml,2组比较差异无统计学意义(P＞0.05).经腹组术中发生大出血3例、膀胱损伤2例、单侧输尿管损伤1例,经腹膜外组术中发生大出血1例、闭孔神经损伤1例、腹膜损伤1例、膀胱三角损伤1例.2组术后留置导尿时间分别为(14.6±3.8)和(12.3±2.9)d,肠功能恢复时间分别为(2.7±0.7)和(2.1±0.5)d,术后住院时间分别为(17.0±3.6)d和(11.2±3.5)d,2组比较差异均有统计学意义(P＜0.05).结论 腹腔镜下前列腺癌根治术经腹膜外比经腹途径具有视野清晰、对腹腔器官影响小、术后恢复快、术后住院短等优点.     

经腹膜外途径腹腔镜前列腺癌根治术中尿控技巧探讨

目的回顾性总结探讨经腹膜外途径腹腔镜下前列腺癌根治术中处理尿控的方法及技巧。方法临床选择T1～T3a前列腺癌患者44例,年龄为58～82岁,平均年龄为70.5岁。术前前列腺总特异性抗原(TPSA)为8.9～38.6 ng/ml。所有患者术前均行经直肠前列腺穿刺活检,病理明确诊断证实为前列腺癌,平均Gleason评分(5.6±2.5)分,44例患者均行经腹膜外途径腹腔镜下前列腺癌根治术。结果 44例患者均顺利完成手术,手术时间150～410分钟,平均手术时间(220±85)分钟;术中出血量300～1500ml,平均(400±220)ml;术后完全尿控33例(75.0%),部分尿控9例(20.5%)(1周后恢复),完全性尿失禁2例(4.5%)(持续3个月以上),术后病理切缘阳性6例(13.6%);直肠损伤1例,经保守治疗治愈。结论腹腔镜下前列腺癌根治术治疗局限性前列腺癌安全、有效,术后尿控效果与术中神经血管束(NVB)、远端尿道保留长度、正确处理膀胱颈部、膀胱尿道吻合的技巧处理及术者的经验相关。     

Laparoscopic radical prostatectomy: initial experience and preliminary assessment after 65 operations

BACKGROUND: Our purpose was to evaluate the technical feasibility, oncological efficacy, and intraoperative and postoperative morbidity of laparoscopic radical prostatectomy. METHODS: We describe an original technique of laparoscopic radical prostatectomy performed in 65 successive patients during 11 months. RESULTS: Radical prostatectomy was performed entirely by laparoscopy in 59 patients (91%). The median operating time was 265 min, including times for lymphadenectomy performed in 33% of patients. Preoperative complications included one rectal injury, sutured laparoscopically with an uneventful postoperative course, and one epigastric artery injury which needed secondary open procedure. The transfusion rate was 15.4% (10 patients). Median postoperative vesical catheterization lasted 7 days. The reduction of postoperative pain allowed rapid discharge of patients, by the fourth postoperative day in 60% of consenting patients. As regards oncological results, resection margins were negative in 57 patients (87.7%). The last prostate-specific antigen (PSA) assay was undetectable (<0.1 ng/ml) in 85.7% of the 42 patients in whom PSA was available more than 1 month after the operation. CONCLUSIONS: Radical prostatectomy can be routinely performed by laparoscopy by an experienced team. Short-term oncological data were identical to the results of conventional retropubic surgery, and morbidity was low. The laparoscopic approach could constitute in the future a technical improvement over radical prostatectomy if long-term oncological results are confirmed and if improvement of intraoperative vision improves the functional results of this operation.     

经腹膜外机器人单孔腹腔镜根治性前列腺切除术的初步应用

经腹膜外机器人单孔腹腔镜根治性前列腺切除术的研究国内鲜有报道。本研究对9例局限性前列腺癌患者采用经腹膜外机器人单孔腹腔镜根治性前列腺切除术,手术均顺利完成,无额外增加辅助孔。手术时间及出血量可控,住院时间短。术后短期随访肿瘤控制及功能恢复效果满意,该术式安全可行,但远期疗效需进一步观察。     

腹腔镜前列腺癌根治术结合精神心理干预治疗局限性前列腺癌的临床研究

目的 研究腹腔镜前列腺癌根治术结合精神心理干预治疗局限性前列腺癌的临床应用效果。方法 通过对本院2015年2月至2017年12月就诊治疗的92例行腹腔镜前列腺癌根治术的患者临床资料做回顾性分析，并根据治疗方式的不同分为观察组、对照组（各46例）。对照组给予腹腔镜前列腺癌根治术治疗，观察组在对照组的基础上结合精神心理干预治疗。比较两组患者治疗前后的SAS、SDS、IPSS、QOL评分及术中情况、住院时间。结果 两组患者手术时间、住院时间、术中出血量情况比较差异均无明显统计学意义（P>0.05）；治疗后两组患者SAS、SDS评分均较治疗前降低（P<0.05），且观察组治疗后SAS、SDS评分均较对照组下降明显（P<0.05）；治疗后两组患者IPSS、QOL评分均较治疗前下降（P<0.05），且观察组IPSS、QOL评分均较对照组下降明显（P<0.05）。结论 腹腔镜前列腺癌根治术结合精神心理干预治疗局限性前列腺癌患者，可有效地改善其负性情绪，减轻排尿症状，提高生活质量。