中华外科杂志
中華外科雜誌
중화외과잡지
CHINESE JOURNAL OF SURGERY
2011年
6期
542-545
,共4页
邵鹏飞%殷长军%孟小鑫%居小兵%吕强%李杰%秦超%张炜%顾民%华立新%徐正铨
邵鵬飛%慇長軍%孟小鑫%居小兵%呂彊%李傑%秦超%張煒%顧民%華立新%徐正銓
소붕비%은장군%맹소흠%거소병%려강%리걸%진초%장위%고민%화립신%서정전
前列腺肿瘤%腹腔镜检查%经腹腔途径%前列腺癌根治术
前列腺腫瘤%腹腔鏡檢查%經腹腔途徑%前列腺癌根治術
전렬선종류%복강경검사%경복강도경%전렬선암근치술
Prostatic neoplasms%Laparoscopy%Transperitoneal approach%Radical prostatectomy
目的 评价改良的经腹腔途径腹腔镜下前列腺癌根治术的手术技术及其临床效果.方法 回顾性分析2008年1月至2010年6月行经腹腔途径腹腔镜下前列腺癌根治术的105例患者资料.患者年龄51～73岁,术前血清特异前列腺抗原平均13.6μg/L,前列腺体积平均45 ml,术前均由病理检查确诊,Gleason评分6～8分,核素骨扫描示无骨转移.经腹腔途径腹腔镜下前列腺癌根治术中对膀胱颈精囊腺分离以及膀胱颈后尿道吻合等技术进行了改良.结果 手术时间65～150 min,半均93 min.术中出血50～400 ml,平均115 ml,术中均未中转开放手术,无大血管及直肠损伤.术后切缘阳性24例,术后吻合口尿漏1例,无肠道并发症.术后平均7 d拔除尿管,拔管后正常尿控64例,术后3个月内恢复尿控33例,术后3～12个月内恢复尿控5例.术后随访5～33个月,平均16个月.随访期间有3例尿失禁,保留性神经患者中15例术后勃起功能良好,17例出现生化复发.结论 经腹腔途径腹腔镜下前列腺痛根治术手术操作空间大,解剖标志清晰,肿瘤治疗效果满意.对膀胱颈分离及后尿道吻合等技术的改进可明显缩短手术时间,提高手术效率,减少手术并发症.
目的 評價改良的經腹腔途徑腹腔鏡下前列腺癌根治術的手術技術及其臨床效果.方法 迴顧性分析2008年1月至2010年6月行經腹腔途徑腹腔鏡下前列腺癌根治術的105例患者資料.患者年齡51～73歲,術前血清特異前列腺抗原平均13.6μg/L,前列腺體積平均45 ml,術前均由病理檢查確診,Gleason評分6～8分,覈素骨掃描示無骨轉移.經腹腔途徑腹腔鏡下前列腺癌根治術中對膀胱頸精囊腺分離以及膀胱頸後尿道吻閤等技術進行瞭改良.結果 手術時間65～150 min,半均93 min.術中齣血50～400 ml,平均115 ml,術中均未中轉開放手術,無大血管及直腸損傷.術後切緣暘性24例,術後吻閤口尿漏1例,無腸道併髮癥.術後平均7 d拔除尿管,拔管後正常尿控64例,術後3箇月內恢複尿控33例,術後3～12箇月內恢複尿控5例.術後隨訪5～33箇月,平均16箇月.隨訪期間有3例尿失禁,保留性神經患者中15例術後勃起功能良好,17例齣現生化複髮.結論 經腹腔途徑腹腔鏡下前列腺痛根治術手術操作空間大,解剖標誌清晰,腫瘤治療效果滿意.對膀胱頸分離及後尿道吻閤等技術的改進可明顯縮短手術時間,提高手術效率,減少手術併髮癥.
목적 평개개량적경복강도경복강경하전렬선암근치술적수술기술급기림상효과.방법 회고성분석2008년1월지2010년6월행경복강도경복강경하전렬선암근치술적105례환자자료.환자년령51～73세,술전혈청특이전렬선항원평균13.6μg/L,전렬선체적평균45 ml,술전균유병리검사학진,Gleason평분6～8분,핵소골소묘시무골전이.경복강도경복강경하전렬선암근치술중대방광경정낭선분리이급방광경후뇨도문합등기술진행료개량.결과 수술시간65～150 min,반균93 min.술중출혈50～400 ml,평균115 ml,술중균미중전개방수술,무대혈관급직장손상.술후절연양성24례,술후문합구뇨루1례,무장도병발증.술후평균7 d발제뇨관,발관후정상뇨공64례,술후3개월내회복뇨공33례,술후3～12개월내회복뇨공5례.술후수방5～33개월,평균16개월.수방기간유3례뇨실금,보류성신경환자중15례술후발기공능량호,17례출현생화복발.결론 경복강도경복강경하전렬선통근치술수술조작공간대,해부표지청석,종류치료효과만의.대방광경분리급후뇨도문합등기술적개진가명현축단수술시간,제고수술효솔,감소수술병발증.
Objective To evaluate the technique and clinical outcomes of modified transperitoneal laparoscopic radical prostatectomy. Methods A total of 105 patients received the operation with age ranging from 51 to 73 years from January 2008 to June 2010. Mean level of serum prostate specific antigen was 13. 6 μg/L and mean prostatic volume was 45 ml. Pathological studies of biopsy confirmed the prostate carcinoma with Gleason score 6-8. Radionuclide bone scan revealed no metastasis. Based on previously retroperitoneal radical prostatectomy, modified technique was applied involving surgical approach, bladder neck dissection and vesicourethral anastomosis. Results Mean operative time was 93 min (65-150 min).Intraoperative blood loss was 115 ml (50-400 ml). No complication of bowl injury occurred. Positive surgical margin was present in 24 patients. Normal continence were seen in 64 patients after catheter removed. Recovery of incontinence within 3 months was seen in 33 patients and 3 to 12 months in 5 patients respectively. Three patients with incontinence were still in the follow-up. Conclusions Transperitoneal laparoscopic radical prostatectomy provides large working space and clear anatomic exposure. Higher efficiency and lower complication rate are obtained through modified laparoscopic technique involving seminal vesicle isolation, bladder neck dissection and vesicourethral anastomosis.
