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.

Laparoscopic extraperitoneal radical prostatectomy

Objective To present the experience of laparoscopic extraperitoneal radical prostatectomy and evaluate its safety and efficacy. Methods A total of 91 patients diagnosed with localized prostate carcinoma were admitted from February 2003 to June 2008. The level of serum PSA ranged from 7. 5 - 47. 0 ng/ml(mean 14. 0 ng/ml). The volume of the prostate ranged from 35 - 75 ml(mean 52 ml). Biopsy was performed before the operation and the pathological results revealed prostate carcinoma with Gleason score no more than 8. CT, MR and ECT revealed there was no lymph node or seminal vesicle involvement and there was no bone metastasis. The procedures were performed with an-tegrade techniques and pelvic lymphadenectomies were performed in 32 cases and nerve-sparings were performed in 11 cases. Results The operation duration ranged from 105 - 270 min (mean 173 min). Intraoperative blood loss was 110 - 1200 ml(mean 315 ml). Incontinence occurred in 19 cases in early stage and 18 cases recovered within 3 months. Positive surgical margin occurred in 11 cases. There was no complication of urethra stricture during 3 - 30 months' follow-up. No lymph node was involved in 32 cases with pelvic lymphadectomy. Five of the 11 cases received nerve-sparing prostatectomy had normal erectile function during the follow-up. Conclusions Laparoscopic extraperitoneal radical prostatectomy is a safe, effective and efficient surgical procedure with the minimal invasion, less morbidity and rapid recovery. Laparoscopic radical prostatectomy is emerging as an alternative to open radical prostatectomy.