腹腔镜前列腺癌根治术

目的总结腹腔镜前列腺癌根治术的经验。方法2004年9月～2005年12月,我科对8例早期局限性前列腺癌行经腹腔腹腔镜前列腺癌根治术,游离前列腺直肠间隙达前列腺尖部,游离膀胱前间隙及耻骨后间隙,缝扎阴茎背深静脉后离断膀胱颈部,重建膀胱颈并与尿道吻合。结果8例腹腔镜前列腺癌根治术均获成功,无一例中转开放手术。手术时间270～420min,平均325min;术中出血量300～1600ml,平均580ml,其中1例由于术中损伤阴茎背深静脉大出血1600ml,需要输血4例。标本切缘阳性1例。术后膀胱尿道吻合口尿漏2例;术后2周拔除导尿管,出现尿失禁2例,1例尿失禁在随访6个月后尿控能力恢复,另1例尿失禁仍存在。8例术后随访10～24个月,平均16个月,排尿均通畅,未出现生化复发现象。结论熟悉前列腺的局部解剖、有良好的腹腔镜器械辅助及熟悉掌握各种腹腔镜下操作技术是开展此手术的关键。

Laparoscopic Radical Prostatectomy

Objective To summarize our experiences with 8 cases of laparoscopic radical prostatectomy (LRP). Methods From September 2004 to December 2005, transperitoneal LRP was performed on 8 patients with localized prostate cancer. During the operation, the space between the prostate and rectum was separated to the level of apex of the prostate, then the retropubic space was separated, and the bladder neck was excised after the deep dorsal penile vein was ligated. Finally, the bladder neck was reconstructed and the urinary tract was anastomosed. Results The procedure was successfully completed in all the 8 cases without converting to open surgery. The operation time ranged from 270 to 420 min with a mean of 325 min; the intraoperative blood loss was 300-1600 ml (mean, 580 ml). One patient had a blood loss of 1600 ml because of intraoperative injury to the deep dorsal penile vein. Four patients received blood transfusion during the operation. Positive margin was found in one case. Two patients developed anastomotic urinary leakage after the operation. Urinary catheter was withdrawn 2 weeks postoperation. Two patients had urinary incontinence, of which, urinary function was recovered in 6 months in one, and was remained in the other. The 8 patients were followed up for 10-24 months (mean,16 months), during which no one had dysuria or biochemical recurrence. Conclusions It is important to master the anatomy of the prostate and the laparoscopic technique, and to use high-quality laparoscope for LRP.