经腹膜外腹腔镜下前列腺癌根治术及其控尿技术

目的 探讨腹膜外途径腹腔镜前列腺癌根治术及其控尿技术的应用价值。方法 前列腺癌患者28例，年龄60～75岁，平均68岁。PSA0．7～23．6ng／ml。TNM分期：T1N0M011例，T2N0M015例，T3aN0M2例。均行腹膜外途径腹腔镜前列腺癌根治术。，术中充分剪开盆筋膜，分离至前列腺尖部，缝扎背血管复合体。分离膀胱颈部（前列腺交界处），横断并尽可能保护颈部括约肌。仔细观察盆底肌肉并于近端剪开前列腺尖部，尽可能保护盆底括约肌，最后缩小并重建膀胱颈口，间断吻合膀胱和尿道。结果 28例手术均顺利完成，手术时间180～380min，平均240min；出血量400～1200ml，平均800ml，15例出血量〉500ml者输血200～800ml。术后病理示切缘阴性25例，3例前列腺尖部切缘阳性者术后加用全雄激素阻断治疗3个月。患者均于术后2周拔除导尿管，3例术后出现轻度尿失禁，经提肛训练等辅助治疗3个月后好转，能自主排尿。术后3个月时PSA0．02～0．10ng／ml。随访1个月～2年，未见肿瘤复发转移。结论 腹腔镜下经腹膜外途径前列腺癌根治术安全、有效，值得临床推广。

Extraperitoneal laparoscopic radical prostatectomy for prostate cancer and functional recovery of urinary continence

Objective To evaluate the surgical technique,urinary continence and clinical efficacy of extraperitoneal laparoscopic radical prostatectomy for prostate cancer. Methods This series included 28 cases of prostate cancer aged 60 -75 years (mean,68 years). The PSA level ranged from 0. 7 ng/ml to 23. 6 ng/ml. TNM classification showed T1N0M0 tumor in 11 cases, T2N0M0 tumor in 15 and T3aN0M0 tumor in 2. All cases underwent extraperitoneal laparoscopic radical prostatectomy. The functional reconstructive technique consisted of preservation of the urethral and bladder outlet sphincter muscles, and reconstruction of the bladder neck. Results All the operations were successful. The operative time was 180 - 380 min( mean, 240 min) ,and the blood loss was 400 - 1200 ml( mean,800 ml) . All the catheter were removed 2 weeks after surgery. Mild urinary incontinence occurred in 3 cases, and it improved after supportive treatment. The PSA level was 0. 02 -0. 10 ng/ml 3 months after operation. No recurrence of prostate cancer was found during the follow-up of 1 month-2 years. Conclusions Extraperitoneal laparoscopic radical prostatectomy is safe and effiective for the treatment of prostate cancer. It can be widely applied in clinical practice.