腹腔镜前列腺癌根治术(附21例报告)

目的探讨腹腔镜前列腺癌根治术的手术技巧和疗效。方法 2005年3月～2008年9月,经腹腔途径行腹腔镜前列腺癌根治术21例(T1a3例,T1b4例,T2a6例,T2b8例),游离膀胱前间隙、盆筋膜,显露前列腺尖部,缝扎阴茎背静脉复合体后离断膀胱颈,游离切除精囊,重建膀胱颈并与尿道吻合。结果 19例手术获得成功,中转开放手术2例,其中阴茎背静脉复合体损伤1例,直肠损伤1例。手术时间155～450min,平均280min;术中出血量170～2500ml,平均470ml。术后病理报告切缘阳性1例。术后尿管留置10～40d,平均14d,无真性尿失禁发生。术后发生漏尿3例,尿道狭窄1例,均治愈。21例随访5～44个月,平均18.5月,PSA0～5.85ng/ml,平均0.23ng/ml,未发现局部复发和远处转移。结论腹腔镜前列腺癌根治术是治疗局限性前列腺癌的安全有效措施。熟练掌握盆腔解剖,预先处理阴茎背静脉复合体,膀胱颈重建和镜下吻合技术是成功实施手术的关键。

Laparoscopic Radical Prostatectomy for Prostate Cancer: Report of 21 Cases

Objective To probe into the skill and efficacy of laparoscopic radical prostatectomy（LRP）in patients with prostate cancer.Methods From March 2005 to September 2008,21 cases of transperitoneal LRP were performed in our hospital.Among the cases,there were 3 cases of T1a,4 cases of T1b,6 cases of T2a,and 8 cases of T2b.During the operation,the retropubic space and pelvic fascia were separated,and the bladder neck was excised after the vein complex was ligated.Then the seminal vesicles were separated and resected.Finally,the bladder neck was reconstructed and anastomosed with the urethra.Results The operation was successfully completed in 19 cases;2 cases were converted to an open surgery because of injury to the dorsal vein complex or the rectum.The operation time ranged from 155 to 450 min（mean,280 min）.The blood loss during the operation ranged from 170 to 2500 ml（mean,470 ml）.One case showed positive surgical margins.After the surgery,the urinary catheter was withdrawn in 10 to 40 days（mean,14 days）,and no true incontinence occurred after decatherization.Urinary leakage was detected in 3 cases,and urethrostenosis was found in 1 case;both the complications were cured afterwards.The 21 patients were followed up for 5 to 44 months with a mean of 18.5 months,during which the mean PSA of the patients was 0.23 ng/ml（range：0-5.85 ng/ml）.No local recurrence or metastasis were found in the patients.Conclusions LPR is a safe and effective procedure for patients with prostate cancer.The keys to the surgery include deep understanding of the pelvic anatomy,pre-treatment of the dorsal vein complex,reconstruction of the bladder neck,and anastomosis.