CAJ | 학술논문

目的：探讨非气腹腹腔镜下前列腺癌根治术的可行性及疗效。方法2012年7月～2013年6月，行非气腹腹腔镜下前列腺癌根治术11例。前列腺特异抗原（PSA）（19．6±17．2） ng/ml，前列腺体积33～78 ml，平均41 ml。临床分期cT1期3例，cT2期6例，cT3期2例。取耻骨上正中切口3～5 cm，用手指钝性分离膀胱前间隙。在腹腔镜或示指引导下于双侧麦氏点下2 cm与脐下弧形穿出3个操作通道。应用悬吊器械提拉下腹壁创造操作的空间，30°腹腔镜通过脐部的通道进入，术者通过两侧的通道及下腹部的小切口进入器械操作。手术操作与传统的腹腔镜下前列腺癌根治术相同。结果11例手术顺利，手术时间（227±61） min，术中出血量（360±101） ml，无直肠损伤等严重并发症。术后病理均为前列腺腺癌，无切缘阳性。随访1～11个月，平均4个月，排尿通畅，无尿失禁。 PSA 0～0．21 ng/ml，平均0．11 ng/ml。结论非气腹腹腔镜下前列腺癌根治术微创、安全、有效。
목적：탐토비기복복강경하전렬선암근치술적가행성급료효。방법2012년7월～2013년6월，행비기복복강경하전렬선암근치술11례。전렬선특이항원（PSA）（19．6±17．2） ng/ml，전렬선체적33～78 ml，평균41 ml。림상분기cT1기3례，cT2기6례，cT3기2례。취치골상정중절구3～5 cm，용수지둔성분리방광전간극。재복강경혹시지인도하우쌍측맥씨점하2 cm여제하호형천출3개조작통도。응용현조기계제랍하복벽창조조작적공간，30°복강경통과제부적통도진입，술자통과량측적통도급하복부적소절구진입기계조작。수술조작여전통적복강경하전렬선암근치술상동。결과11례수술순리，수술시간（227±61） min，술중출혈량（360±101） ml，무직장손상등엄중병발증。술후병리균위전렬선선암，무절연양성。수방1～11개월，평균4개월，배뇨통창，무뇨실금。 PSA 0～0．21 ng/ml，평균0．11 ng/ml。결론비기복복강경하전렬선암근치술미창、안전、유효。
Objective To explore the feasibility and efficacy of gasless laparoscopic radical retropubic prostatectomy for the treatment of prostatic carcinoma . Methods Eleven cases of prostate cancer were treated by antegrade radical retropubic prostatectomy from July 2012 to June 2013.Prostate specific antigen ( PSA) was (19.6 ±17.2) ng/ml;prostate volume was 33-78 ml (average, 41 ml); clinical stages included 3 cases of cT1, 6 cases of cT2, and 2 cases of cT3.The surgery procedures were described as follows:an extraperitoneal retropubic space was developed with finger manipulations through a 3-to 5-cm long suprapubic incision.The surgical view was secured with the subcutaneous abdominal wall-lift method.Three trocars were inserted at lower abdomen, and a 30-degree, 10-mm laparoscope was inserted via transumbilical incision .Surgical procedures were performed using conventional laparoscopy and instruments . Results All the 11 laparoscopic surgeries were accomplished successfully .The operative time was ( 227 ±61 ) min and blood loss was ( 360 ±101 ) ml.No rectal injury or other severe complications were observed . Histopathologic study showed prostate cancer for all cases .No cases had positive surgical margins .All cases were followed up from 1 to 11 months (average, 4 months) and no dysuria or permanent urinary incontinence was observed .PSA was 0-0.21 ng/ml (average, 0.11 ng/ml). Conclusion Gasless laparoscopic radical retropubic prostatectomy is minimally invasive , safe and effective for prostatic carcinoma .