减少耻骨后根治性前列腺切除术中出血的体会

目的:探讨减少开放耻骨后根治性前列腺切除术(RRP)出血的有效方法。方法:对100例前列腺癌患者行RRP,前50例(A组)采用Walsh或poor方法处理耻骨后背侧静脉复合体(DVC),后50例(B组)在A组的基础上增加3项止血措施:①在DVC远端预置7号连续缝线;②用4-0可吸收线连续缝合前列腺尖端血管蒂;③在游离神经血管束(NVB)前预置4-0可吸收线或游离NVB后用4-0可吸收线连续缝合肛提肌筋膜残存侧和直肠浆膜层上方的狄氏筋膜深层。通过术中出血量、术中输血量、手术时间、手术前后血红蛋白差值来比较3项止血措施在RRP中的作用。结果:A组与B组在年龄、PSA、Gleason评分、临床分期、前列腺体积、手术时间、手术前后血红蛋白差值无明显差异(P>0.05),A组出血量和输血量分别为(1 103.00±528.03)ml和(482.00±364.60)ml,明显高于B组的(528.00±258.96)ml和(140.00±266.28)ml(P<0.05)。结论:通过在DVC远端预置连续缝线,离断尿道后用细可吸收线连续缝合前列腺尖端血管蒂,在NVB上方预置细可吸收线或在游离NVB后用4-0或细的可吸收线连续缝合肛提肌筋膜残侧和直肠切除术上方狄氏筋膜深层,可在RRP中达到明显减少术中失血的效果。

Experience in reducing intraoperative blood loss in radical retropubic prostatectomy

Objective: To search for an effective method of reducing intraoperative blood loss in radical retropubic prostatectomy(RRP).Methods: We performed RRP for 100 patients with prostate cancer,50(group A) with the Walsh or Poor method for handling the dorsal venous complex(DVC),and the other 50(group B) through the following three additional procedures for hemostasis: first placing a #7 prophylactic suture in the distal position of DVC,then ligating the vascular bundle of the prostatic apex with continuous 4-0 Vicryl sutures,and lastly placing a 4-0 absorbable suture followed by freeing the neurovascular bundle(NVB) or freeing NVB before suturing the remained levator ani myofascia and the deep layer of Denovilliers' fascia above the rectal serosa with 4-0 Vicryl.We assessed the effects of the three hemostatic methods in RRP by comparing the volumes of intraoperative blood loss and transfusion,operation time and perioperative levels of hemoglobin.Results: There were no significant differences between groups A and B in age,PSA,Gleason score,clinical stage,prostate volume,operation time and perioperative hemoglobin levels(P>0.05).The volumes of intraoperative blood loss and transfusion were markedly higher in group A(1 103.00±528.03] ml and 482.00±364.60] ml) than in B(528.00±258.96] ml and 140.00±266.28] ml)(P<0.05).Conclusion: Intraoperative blood loss in RRP could be significantly decreased by placing a prophylactic hemostatic suture in the distal position of DVC,continuous suture of the vascular bundle of the prostatic apex after cutting off the urethra,and placing a fine absorbable suture above NVB or continuous suture of the remained levator ani myofascia and the deep layer of Denovilliers' fascia above the rectal serosa with absorbable sutures after freeing NVB.