摘要
目的探讨经膀胱途径单孔腹腔镜下前列腺癌根治术（transvesical single．sitelaparo．scopic radical prostatectomy，TVSSLRP）的手术技巧和疗效。方法选取2010年11月至2011年5月局限性前列腺癌患者8例。年龄37～65岁，平均58岁。体质指数（body mass index，BMI）20．0～26．0kg／m。，平均22．5kg／m2。术前PSA0．98～10．04μg／L，平均7．50μg／L。国际勃起功能指数（IIEF-5）≥21分7例，〈21分1例。术前穿刺活检病理TNM分期T1a期3例，T2a期5例。Gleason评分2＋2分4例，3＋2分3例，3＋3分1例。D’Amico风险分层均为低风险。全麻下行TVSSLRP，手术由同一名术者完成。使用自制3通道单孔套管建立气膀胱操作通道。远离输尿管开口切开膀胱颈后缘，分离并切断双侧输精管，游离双侧精囊，切开狄氏筋膜，分离前列腺后壁。沿前列腺两侧做环形切口方便暴露前列腺侧韧带，筋膜内层面保留两侧阴茎勃起神经血管束。沿前列腺两侧游离至耻骨后，紧贴前列腺表面切断耻骨前列腺韧带，推开耻骨后血管复合体，分离前列腺尖部，切断尿道。为减少膀胱尿道吻合张力，在膀胱颈两侧和6点处切开膀胱黏膜及黏膜下层，用V—LocTM免打结缝线行膀胱尿道吻合。结果本组8例TVSSLRP均顺利完成，无增加辅助通道。手术时间75～180min，平均125min。术中出血量85—450ml，平均140ml，无输血患者。术中无手术并发症发生。术后病理检查分期pT：。期3例，pT2b。期4例，pT2a。期1例；Gleason评分2＋2分2例，3＋2分4例，3＋3分2例；手术切缘均阴性。术后拔除尿管时间9～16d，平均14d，拔管后控尿均满意，无尿失禁。住院天数13～25d，平均17d。术后随访12—18个月，平均14个月，无尿道狭窄和生化复发发生。术后6个月5例患者勃起功能满意，IIEF-5≥21分。结论经膀胱途径单孔腹腔镜下前列腺癌根治术能有效保护阴茎勃起神经和控尿神经，肿瘤根治疗效好。
Objective To investigate the feasibility of applying transvescal approach laparoendo- scopic single-site radical prostatectomy （TVSSLRP） and assess the oncological and functional outcomes. Methods Eight patients with clinically localized prostate cancer （PCa） of low risk underwent TVSSLRP. Demographic data were accrued including patient age, body mass index （BMI） , preoperative PSA level, the International Index of Erectile Function 5, biopsy Gleason score, clinical TNM stage and D＇Amico risk clas- sification. One surgeon performed all TVSSLRP procedures. A homemade triple-port was introduced percuta- neouly into the bladder to establish pneumovesicum through a 4 cm incision. The major steps of the surgery were described as follows ： initial incision was made along posterior margin of the bladder neck to expose bi- lateral vas deference and spermatic vesicle. After opening Denonvilliers＇ fascia and extending the space to lateral prostatic pedicles, an intra-fascial nerve sparing procedure was performed. The puboprostatic liga- ments were then separated close to the prostate surface and the dorsal vein complex was cautiously swept off. Subsequently, careful apical dissection and urethral transection was sequentially conducted. To reduce the tension of vesico-urethral anastomosis, 3 additional incisions parallel to vesio-urethral margin were created and a novel tension - reduced V-LocTM barbed polydioxanone sutures was used. Results All the opera- tions were successfully performed and there was no conversion to standard laparoscopic approach or open sur- gery. The total operative time range was 75 - 180 min with mean time of 125 rain. The blood loss was 85 - 450 ml with mean ld0 ml and no blood transfusion was required. The catheter was removed after a mean （range） of 14 （9 -16） days. No intra-operative complications occurred. No patient had positive surgical margins. The mean （range） hospital stay was 17 （13 -25 ） days after surgery, All the cases were continent after removal of the catheter. No cases demonstrated vesico-urethral stricture and biochemical recurrence on 12 - 18 months follow up postoperatively. Conclusions TVSSLRP is technically feasible for cases with organ-confined prostate cancer with good oncological and functional results.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2012年第10期753-756,共4页
Chinese Journal of Urology
基金
中山大学5010计划项目（2007028）
中山大学创新团队培育项目（82000-3281902）
关键词
腹腔镜
前列腺癌
前列腺癌根治术
经膀胱途径
单孔
Laparoscope
Prostate cancer
Radical prostatectomy
Transvesical
Laparoen-doscopic single-site
