腹腔镜前列腺癌根治术36例报告

目的探讨腹腔镜前列腺癌根治术(laparoscopic radical prostatectomy,LRP)的可行性和手术技巧。方法2005年3月～2008年12月,行LRP36例。平均年龄64岁(51～73岁),术前病理检查均证实为前列腺癌。T111例,T225例。21例参照Montsouris方法行经腹腔途径LRP,15例行经腹膜外途径LRP。结果平均手术时间265min(155～480min),平均出血量455ml(170～2500ml)。中转开放手术3例,其中2例为阴茎背静脉复合体出血,1例为直肠损伤。术后病理报告切缘阳性2例。术后尿管留置10～30d,平均14d,无真性尿失禁发生。术后漏尿6例,尿道狭窄2例。术后平均随访15.5月(2～44个月),穿刺孔皮下种植转移1例,余35例无复发转移。术后1个月前列腺特异抗原(PSA)0～5.85ng/ml。结论LRP治疗局限性前列腺癌安全有效。熟练掌握盆腔解剖,预先处理阴茎背静脉复合体,熟练掌握膀胱颈重建和镜下吻合技术是成功完成手术的关键。

Laparoscopic Radical Prostatectomy: Report of 36 Cases

Objective To probe into the feasibility and skills of laparoscopic radical prostatectomy （LRP） for patients with prostate cancer. Methods From March 2005 to December 2008, 36 cases of localized prostate cancer treated with LRP were analyzed retrospectively. The patients were aged 51 to 73 years with a mean of 64 years. All the patients were diagnosed by preoperative pathological biopsy. Eleven of them were T1 and 25 were T2. LRP was performed via transperitoneal approach according to Montsouris’ method in 21 of the patients, and through extraperitoneal route in the other 15. Results The mean operation time was 265 minutes in our patients （ranged from 155 to 480 minutes）. The mean blood loss was 455 ml （ranged from 170 to 2500 ml）. During the operation, three patients were converted to open surgery owing to hemorrhage at the dorsal vein complex （two cases） or injury to the rectum （one case）. Postoperative pathological examination showed positive surgical margins in two cases. After the operation, urinary catheter was withdrawn in 10 to 30 days （14 days on average）, none of the patients developed true incontinence. Urine leak occurred in six cases, and urethrostenosis was detected in two. The patients were followed up for a mean of 15.5 months （ranged from 2 to 44 months）; during the period, subcutaneous metastasis at the site of skin puncture was found in one patient; no metastasis or recurrence were detected in the other 35 patients. Examination of serum PSA carried out in one mouth after the operation showed the result ranged from 0 to 5.85 ng/ml. Conclusions LRP is an effective and safe approach for localized prostate cancer. Deep comprehension of pelvic anatomy, pretretment of the dorsal vein complex, and surgical skills of bladder neck reconstruction and laparoscopic anastomosis are the keys to accomplish LRP.