经脐单孔腹腔镜腹膜外前列腺癌根治术7例报告

目的：报告经脐腹膜外单孔腹腔镜前列腺癌根治术的初步经验。方法：20110年2～11月采用经脐单孔腹腔镜腹膜外前列腺癌根治术治疗经活检确诊为前列腺癌患者7例，采用“两环一套法”自制单孔腹腔镜开口器，手术器械包括预弯抓钳、吸引器、针持。其余为传统腹腔镜器械。在脐下缘取2．5cm长弧形切口，进入腹膜外问隙，置人开口器建立单孔腹腔镜手术工作通道，再依次行双侧盆腔淋巴结清扫、前列腺癌根治术，最后采用一针连续缝合法行膀胱颈尿道吻合。记录手术时间、失血量、输血量、并发症发生情况。术后第3、6个月随访，复查血清PSA，了解尿控情况和患者对手术美容效果的满意度。结果：手术时间210～420min，平均272min；术中失血量为50～500ml，平均170ml。2例患者术中需要输浓缩红细胞2～3U，余未输血。仅1例手术需要增加2个工作通道，余患者无中转开放手术或增加工作通道，无围手术期死亡及严重并发症的发生。所有患者排尿可控，仅最后1例患者夜间需预防性使用尿垫1块。术后切口瘢痕隐匿在脐部皱褶内，患者对切口美容效果很满意。结论：在合理选择患者的前提下，采用经脐单孔腹腔镜腹膜外前列腺癌根治术是安全可行的，美容效果很好。“两环一套法”自制开口器能够保证手术顺利实施，性价比高。短期随访显示肿瘤控制及尿控效果好，远期效果需待长期随访来证实。

Transumbilical Laparoendoscopic Single-Site Retroperitoneal Radical Prostatectomy(Report of 7 Cases)

Objective：To report our initial experience in 7 cases of transumbilical laparoendoscopic single site surgery （U-LESS） extraperitoneal radical prostatectomy. Methods： From Feburary 2010 to October 2010, 7 patients with organ-confined prostate cancer underwent LESS extraperitoneal radical prostatectomy and bilateral pelvic lymphadenectomies. Homemade single multilumen port was inserted through a solitary 2.5 cm curved periumbilical incision. Both prebent and conventional laparoscopic instruments were employed in procedure. After prostate specimen was removed, the vesicourethral anastomoses were completed with continuous suture technique. Operative data was recorded. Patients were followed-up at 3 months intervals postoperatively,including PSA level,continence and cosmetic questionaire. Results： The mean operation time was 210-420 rain（mean 272 min）. The estimated intraoperative blood loss was 50-500 ml（mean 170 ml） ,and blood transfusion was needed in 2 case with 2 or 3 units. Two extra ports were added in one case due to large adenoma,and no conversion or more ports needed in rest 6 cases. Final pathology revealed prostate carcinoma with stage T2a （5 cases） and T2b （2 cases）. Pelvic lymph nodes and the surgical margins were free of tumor invasion. Gleason score were 4-7 point （mean 5. 2）. Catheters were removed 3 weeks postoperatively. No severe complications were observed during perioperative period. Serum PSA level was less than 0.2 ng/ml postoperatively. Continence was achieved in all patients, besides,one pad was used in case of need during nighttime for last patient. One patient was present with vesicourethral anastomotic stricture 6 weeks after operation,and cured by internal urethrotomy. All patients were satisfied with cosmetic results. Conclu sions：Although LESS extraperitoneal radical prostatectomy is technically challenging but feasible safe and effective. Rate for convertion or requirement of extra port is rare in selected patients. Homemade muhilumen port is simple and cost-effective for LESS procedure. Satisfactory cosmetic results could be achieved with transumbilical I.ESS procedure. Long time follow-up is necessary to reveal the role of I.ESS in radical prostatectomy regarding the oncologic and functional outcome.