CAJ | 학술논문

目的总结利用3D腹腔镜行根治性膀胱、前列腺切除手术的初步经验. 方法 2012年10月至2013年6月收治的男性患者46例.年龄56～78岁,平均65岁.其中22例诊断为膀胱癌,术前分期T1期6例,T2期10例,T3期6例；24例诊断为前列腺癌,术前分期T1c期7例,T2a期5例,T2b期3例,T2c期2例,T3a期7例,术前tPSA 6.5～33.5 μg/L,中位tPSA 14.5 μg/L.所有患者术前排尿、控尿功能良好.22例膀胱癌患者行3D腹腔镜下根治性膀胱切除-原位回肠新膀胱术,24例前列腺癌患者行3D腹腔镜下根治性前列腺切除术.记录患者的手术时间、出血量、术后住院时间、并发症发生情况、随访情况等. 结果 46例手术均在3D腹腔镜系统下完成,无中转开放手术或普通腹腔镜手术.22例根治性膀胱切除-原位回肠新膀胱术手术时间210～350 min,平均255 min；出血量100～300 ml,平均150 ml；术后住院天数9～21 d,平均15d；围手术期出现膀胱-尿道吻合口漏1例,肠梗阻1例,淋巴漏1例.24例根治性前列腺切除术手术时间90～200 min,平均103 min；出血量50～200 ml,平均78 ml；术后住院天数7～17d,平均13d；围手术期出现膀胱-尿道吻合口漏1例.随访1～8个月,膀胱癌患者术后1个月日间控尿率22.7％(5/22)、夜间控尿率4.5％(1/22)；术后3个月日间控尿率66.7％(10/15)、夜间控尿率40.0％(6/15)；术后6个月日间控尿率85.7％(6/7)、夜间控尿率57.1％(4/7).前列腺癌患者术后1个月控尿率79.1％(19/24),术后3个月控尿率88.9％(16/18),术后6个月控尿率100.0％(8/8).所有患者均未见肿瘤复发.术前6例患者勃起功能良好(IIEF-5≥16),3例术后6个月勃起功能恢复良好(IIEF-5≥16). 结论 3D腹腔镜有良好的立体视野,能增加手术的精确性,在保证肿瘤治疗效果的同时可以更好地改善术后早期控尿情况及性功能的恢复.
목적 총결이용3D복강경행근치성방광、전렬선절제수술적초보경험. 방법 2012년10월지2013년6월수치적남성환자46례.년령56～78세,평균65세.기중22례진단위방광암,술전분기T1기6례,T2기10례,T3기6례；24례진단위전렬선암,술전분기T1c기7례,T2a기5례,T2b기3례,T2c기2례,T3a기7례,술전tPSA 6.5～33.5 μg/L,중위tPSA 14.5 μg/L.소유환자술전배뇨、공뇨공능량호.22례방광암환자행3D복강경하근치성방광절제-원위회장신방광술,24례전렬선암환자행3D복강경하근치성전렬선절제술.기록환자적수술시간、출혈량、술후주원시간、병발증발생정황、수방정황등. 결과 46례수술균재3D복강경계통하완성,무중전개방수술혹보통복강경수술.22례근치성방광절제-원위회장신방광술수술시간210～350 min,평균255 min；출혈량100～300 ml,평균150 ml；술후주원천수9～21 d,평균15d；위수술기출현방광-뇨도문합구루1례,장경조1례,림파루1례.24례근치성전렬선절제술수술시간90～200 min,평균103 min；출혈량50～200 ml,평균78 ml；술후주원천수7～17d,평균13d；위수술기출현방광-뇨도문합구루1례.수방1～8개월,방광암환자술후1개월일간공뇨솔22.7％(5/22)、야간공뇨솔4.5％(1/22)；술후3개월일간공뇨솔66.7％(10/15)、야간공뇨솔40.0％(6/15)；술후6개월일간공뇨솔85.7％(6/7)、야간공뇨솔57.1％(4/7).전렬선암환자술후1개월공뇨솔79.1％(19/24),술후3개월공뇨솔88.9％(16/18),술후6개월공뇨솔100.0％(8/8).소유환자균미견종류복발.술전6례환자발기공능량호(IIEF-5≥16),3례술후6개월발기공능회복량호(IIEF-5≥16). 결론 3D복강경유량호적입체시야,능증가수술적정학성,재보증종류치료효과적동시가이경호지개선술후조기공뇨정황급성공능적회복.
Objective To assess the preliminary experience of laparoscopic radical cystectomy and prostatectomy with three-dimensional(3D)laparoscopy.Methods From Oct.2012 to Jun.2013,46 patients had accepted 3D laparoscopic radical cystectomy for bladder cancer(22 cases)and prostatectomy for prostate cancer(24 cases)in our hospital.The perioperative and follow-up data(operative time,estimated blood loss,complications,post-operative hospital stay,pathological data,oncologic outcome,continence and erectile function)were analyzed.Results All 46 operations were finished uneventfully,without conversion to open or conventional laparoscopic surgery.The mean operative time was 103 min for radical prostatectomies,255 min for radical cystectomies with orthotopic ileal neobladder,the mean estimated blood loss was 82 ml for radical prostatectomies,150 ml for radical cystectomies.Follow-up data showed excellent oncological results and satisfactory functional results.Continence rate after cystectomy is 66.7％ at 3 months and 85.7％ at 6 months postoperatively in daytime,40.0％ and 57.1％ at night respectively.Continence rate after prostatectomy is 79.1％ at 1 month,88.9％ at 3 months and 100.0％ at 6 months postoperatively.Conclusions 3D laparoscopy provides high-quality 3D endoscopic view and facilitates precise manipulation during surgery,resulting in satisfactory oncological and functional outcomes for the pelvic surgeries.