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.

Improve recovery of urinary continence following laparoscopic radical prostatectomy: a clinical report of 51 cases

Objective To present the clinical results of 51 patients of clinically localized prostate cancer treated by laparoacopic radical prostatectomy, especially recovery of urinary continence.To analysis how to improve recovery of urinary continence. Methods From February 2004 to March 2008, we performed LRP on 51 patients.All patients were diagnosed by pathological result preoperatively.Tla-lb 4 cases (8%), Tic 15 cases (29%), T2a7 cases (14%),T2b 5 cases (10%),T2c 20 cases(39%).Results Forty-nine cases were treated by LRP successfully.There were two cases converted to open surgery.Urine leaking happened in 3 cases, but recovered without intervention.Urinary catheter duration was 14-45 days ( mean 16 days).Six months and 12 months after LRP, incontinence happened 7/39 cases (17.9% ) and 5/20 cases (25%) respectively.Complete incontinence happened in one case.The ratio of incontinence happened in the first 20 cases and the following 31 cases were 6/20(30% ) and 7/31 (22%) respectively.There were two cases had rectal injury.Both cases underwent colostomy.Duration of follow up were from 3-53 months ( mean 17 months).Two cases recurred. One of them was treated with hormone therapy, the other one died of operation for lung metastasis.Other patients' serum total PSA were less than 0.2 μg/L.Conclusions Extraperitoneal laparoscopic radical prostatectomy is efficient and safe approach for localized prostate cancer.The correct handling of puboprostatic ligaments, external urethral sphincter and neurovascular bundle are important for recovery of urinary continence.And so does the experience of LRP.