经腹膜外途径腹腔镜下前列腺癌根治术

目的 探讨经腹膜外途径腹腔镜下前列腺癌根治术的临床效果及安全性. 方法 临床局限性前列腺癌患者15例,均行经腹膜外途径腹腔镜下前列腺癌根治术.术前平均总PSA 8.1ng/ml,平均Gleason评分5.7±1.3.采用切开腹白线的"北京医院建立腹膜外操作间隙技术"建立腹膜外间隙.手术过程中分离,切割和止血均采用超声刀技术.记录患者手术时间,估计术中出血量、术中并发症、留置引流管时间、术后疼痛指数、术后住院时间、术后病理和PSA等临床资料,并对结果进行分析. 结果 15例手术14例腹腔镜完成,1例因吻合困难中转开放手术.手术时间(316±74)min;术中估计出血量(408±362)ml.5例(33%)患者接受了输血,无直肠及输尿管损伤.术后第1和2天疼痛指数分别为2.3和1.4分.术后留置导尿(14.1±2.9)d,平均住院时间(19.5±4.9)d.术后Gleason评分5.7±1.8.标本切缘阳性2例(13%).病理检查未发现淋巴结转移病例.随访1～12个月,完全控尿10例(67%),PSA<0.2 ng/ml 12例.结论 经腹膜外途径腹腔镜下前列腺癌根治术是一种安全可行的局限性前列腺癌的手术方式.

Extraperitoneal laparoscopic radical prostatectomy

Objective To evaluate the efficiency and safety of extraperitoneal laparoscopic radi-cal prostatectomy for the treatment of localized prostate cancer. Methods Fifteen localized prostate cancer patients were treated with extraperitoneal laparoscopic radical prostatectomy. The mean pre-op-erative PSA was 8.1 ng/ml and prostate biopsy pathological Gleason score was 5.7±1.3. The Beijing Hospital Technique characterized by cutting directly into linea alba abdominis was used to establish the extraperitoneal space. Harmonic scrapple was used in dissection and haemostasis during the proce-dure. This technique was evaluated in respects of operating time, estimated blood loss, complications during surgery, postoperative complications, post-operative pain score (NRS), catheterization time, length of hospital stay, pathological results and post-operative PSA. Results All the surgeries had been completed successfully except 1 case converted to open surgery. The average operation time was (316±74)min, the average estimated blood loss was (4084±362)m1. There were 5 cases accepted blood transfusion. No rectal or ureteral injury happened during operation. The NRS at post-operative day 1 and day 2 were 2.3 and 1.4. The average length of hospital stay was (19.5±4.9)d. The cathe-terization time was (14.1±2.9)d. There were 2 cases (13%) with positive surgical margins. No case was found having lymph node metastasis. During the 1-12 month follow up, 10 cases (67%) were continence. PSA in 12 cases was lower than 0.2 ng/ml. Conclusion Extraperitoneal laparoscopic radical prostatectomy is feasible and safe in the treatment of localized prostate cancer.