摘要
目的：探讨经腹膜外途径腹腔镜下前列腺癌根治术（LRP）中及术后并发症的处理对策。方法：局限性前列腺癌患者15例,年龄60～78岁,平均67岁。前列腺特异性抗原（PSA）为8.6～37.4μg/L。TNM分期均≤T2CN0M0。所有患者术前均行经直肠前列腺穿刺活检,病理明确诊断证实为前列腺癌,15例患者均行经腹膜外途径LRP。结果：15例患者均顺利完成手术,手术时间170～410min,平均（230±90）min;术中出血量为420～1 100ml,平均（500±220）ml,术中输血2例均为出血量〉800ml。术后病理结果：切缘阳性1例,Gleason评分≤6分的患者4例,7分的患者7例,≥8分的患者4例。所有患者均于术后2周拔除导尿管,1例术后出现轻度尿失禁,经提肛训练等辅助治疗1个月后尿失禁痊愈,能自主排尿。1例患者出现出现尿道直肠瘘,给予留置尿管3个月、半流质饮食,3个月后肠漏消失,拔除尿管痊愈;15例患者均定期随访,随访至今;术后3个月时PSA0.001～0.080μg/L,平均（0.040±0.016）μg/L,无一例生化复发。结论：经腹膜外途径LRP安全、有效,对膀胱颈分离、前列腺游离及后尿道吻合技术、技巧的提高可以明显缩短手术时间及术后并发症的发生。
Objective：To investigate the clinical curative effect observation of extraperitoneal laparoscopic radical prostatectomy（LRP）for prostate cancer.Method：Fifteen cases with localized prostate cancer subjected to operation were retrospectively analyzed,with age from 60to 78（mean 67）years,prostate specific antigen（PSA）level was 8.6-37.4μg/L,TNM ≤ T2CN0M0.All patients were pathologic diagnosed with prostate cancer by preoperative prostate biopsy of prostate surgery,and all of them were treated extraperi toneal LRP.Result：The all operations were successful,the time of operation was 170-410（mean 230±90）min,the blood loss was 420-1 100（mean 500±220）ml during operation.2cases because of intraoperatie bleeding is greater than 800ml for blood transfusion.After operations the pathological replacements were prostatic carcinoma,1case had positive surgical margin,the rest was negative.Gleason score≤6points in 4cases of patients,Gleason score=7points in 7cases of patients,Gleason score≥8points in 4cases of patients.Urinary eatheter was withdrew in 2weeks after the operation.1case had mild urinary incontinence,which was improved after the training of contaction anus and the aided treatment.1case with rectal injury healed by indwelling catheter and giving semi-liquid diet for 3months.Regular follow-up was done after operation with,PSA 0.01-0.08μg/L in the third month after surgery.Conclusion：Extraperitoneal LRP is safe and effective for the treatment of prostate cancer.Improvement of the bladder neck,dissection prostate mobilization and posterior urethral anastomosis,could shorten the operation time obviously and reduce the occurrence of postoperative complications.
出处
《临床泌尿外科杂志》
2014年第7期605-606,610,共3页
Journal of Clinical Urology
关键词
腹膜外途径
腹腔镜
前列腺癌根治术
并发症
extraperitoneal approach
laparoscopy
laparoscopic radical prostatectomy
