腹腔镜前列腺癌根治术的疗效评估

目的:探讨腹腔镜根治性前列腺切除术的疗效。方法:2009年9月-2011年9月,我科对81例早期局限性前列腺癌行腹膜外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,离断膀胱颈部、耻骨前列腺韧带及尿道,重建膀胱颈并与尿道吻合。结果:81例腹腔镜前列腺癌根治术均获成功,无1例中转开放手术。手术时间100-270min,平均150min。术中出血量100-700ml,平均210ml。需要输血5例(6.17%)。标本切缘阳性5例(6.17%)。术后膀胱尿道吻合口尿漏2例(2.47%),术后2周拔除导尿管,出现尿失禁8例(9.87%),其中7例(8.64%)随访6个月尿控恢复良好,1例未能恢复。81例术后随访21-45个月,平均30个月,排尿均通畅,未出现生化复发。术前41例(50.6%)有阴茎勃起功能的患者根据国际阴茎勃起功能指数(IIEF-5)评分分组进行术后变化评估。术后IIEF-5评分显著下降,各评分组间的差异无统计学意义。44例(54.3%)可通过使用药物进行性生活。结论:腹腔镜前列腺癌根治术是一种安全、有效、创伤小、并发症低、术后恢复快的手术方法。但长期疗效尚待进一步观察。

Laparoscopic Radical Prostatectomy: An Assessment of 81 Cases

Objective:To evaluate the efficacy of laparoscopic radical prostatectomy(LRP)in patients with prostate cancer.Methods:From September 2009 to September 2011,extraperitoneal LRP was performed on 81 patients with localized prostate cancer.The space between the prostate and rectum was separated to the level of apex of the prostate,then the retropubic space was separated,and the bladder neck,the puboprostatic ligaments and the urinary tract was excised.Finally,the bladder neck was reconstructed and the urinary tract was anastomosed.Results:The procedure was successfully completed in all the 81 cases without converting to open surgery.The operation time ranged from 100 to 270 min with a mean of 150 min;the intraoperative blood loss was 100-700ml(mean 210 ml).Five patients received blood transfusion during the operation(6.17%).Positive margin was found in five cases(6.17%).Two patients developed anastomotic urinary leakage after the operation(2.47%).Urinary catheter was withdrawn 2weeks postoperation.Eight patients had urinary incontinence,and among them,urinary function was recovered in 6months in seven,and unchanging remained in the other.The 81 patients were followed upfor 21-45months(mean 30months),during which no one had dysuria or biochemica recurrence.41cases(50.6%)who had erectile function were divided into 3groups based on the international index of erectile function(IIEF-5)for the evaluation of the postoperative erectile function.Postoperative IIEF-5scores were significantly decreased,but the difference between groups was not significant.44cases(54.3%)could have intercourse by the use of medications such as Viagra.Conclusion:These results suggest that laparoscopic radical prostatectomy is a safe,effective and minimally invasive surgery with low complication and rapid recovery.However,long-term cancer control and functional recovery need further investigation.