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。

Extraperitoneal laparoscopic radical prostatectomy: a report of 9 cases

Objective To evaluate the surgical technique and clinical efficacy of extraperitoneal laparoscopic radical prostatectomy. Methods A total of 9 patients diagnosed with prostate cancer underwent extraperitoneal laparoscopic radical prostatectomy from January 2006 to October 2008. The procedures were performed with antegrade techniques. Before the bladder neck transaction, the retropubic dorsal vein complex was sutured with 1-0 absorbable suture. Results All operations were successful without converting to open surgery. The operative time ranged from 180 to 510 rain with a mean of 322 min, the intraoperative blood loss was 200-1500ml （mean, 433ml）. The bowel activity was recovered with 48 hours after surgery. The patients were ambulant 2 to 3 days postoperatively. No rectal injury and urinary leakage were occurred in this group. Positive margin was found in one case. Urinary incontinence occurred in 1 case and improved after supportive treatment. During the following period of 5-33 months for 7 cases, no local recurrence or distant metastasis were found. The postoperative PSA level was 0-0.1 ng/ml. Conclusions Extrapefitoneal laparoscopic radical prostatectomy is safe and effective for the treatment of prostate cancer with advantages of minimal invasion, rapid recovery. However, extraperitoneal laparoscopic radical prostatectomy is a complicated surgery, which only experienced laparoscopic urologic surgeon can perform.