CAJ | 학술논문

目的探讨经腹膜外途径腹腔镜下根治性前列腺切除术(extra-peritoneal laparoscopic radical prostatectomy,eLRP)治疗高危前列腺癌的疗效和可行性.方法 2009年2月至2013年12月对满足D'Amico高危前列腺癌定义的121例患者行eLRP.患者年龄54～82岁,平均70岁.术前PSA 2.40～111.31 μg/L,平均25.45μg/L.Gleason评分6～ 10分,平均8分.临床分期T1～ T2b期52例,T2c期58例,T3a期8例,T3b期3例.记录手术时间、出血量、术中并发症等资料,观察术后漏尿、淋巴漏等短期并发症,随访尿控、勃起功能恢复以及PSA变化.结果 121例手术均顺利完成.手术时间105 ～341 min,平均165 min.术中出血50～ 1500 ml,平均150 ml.术中发生大出血4例,输血1例;术中发生单侧闭孔神经损伤3例,未予特殊处理.肠功能恢复时间24～72 h,平均35 h.留置尿管时间7 ～14d,平均9d.术后发生吻合口漏尿12例,其中术后1d5例、2d3例、3d2例,术后4、5d各1例.术后5d出现下肢静脉血栓1例.术后2d出现淋巴漏1例,延长引流时间后自愈.术后2～4个月3例发生膀胱尿道吻合口狭窄,2例经尿道扩张后症状缓解,1例经尿道镜内切开好转.术后病理报告切缘阳性18例,精囊腺侵犯21例,髂血管淋巴结阳性9例.术后住院时间5～22 d,平均10d.术后96例1年内恢复控尿,11例存在不同程度的尿失禁.术中保留性神经51例,术后2～12个月勃起功能恢复者33例.术后6周复查血PSA 0 ～8.75 μg/L,平均0.14μ g/L.术后5～ 36个月,平均18个月48例出现生化复发.结论 eLRP治疗高危前列腺癌的疗效满意,是一种安全可行的治疗方式.
목적 탐토경복막외도경복강경하근치성전렬선절제술(extra-peritoneal laparoscopic radical prostatectomy,eLRP)치료고위전렬선암적료효화가행성.방법 2009년2월지2013년12월대만족D'Amico고위전렬선암정의적121례환자행eLRP.환자년령54～82세,평균70세.술전PSA 2.40～111.31 μg/L,평균25.45μg/L.Gleason평분6～ 10분,평균8분.림상분기T1～ T2b기52례,T2c기58례,T3a기8례,T3b기3례.기록수술시간、출혈량、술중병발증등자료,관찰술후루뇨、림파루등단기병발증,수방뇨공、발기공능회복이급PSA변화.결과 121례수술균순리완성.수술시간105 ～341 min,평균165 min.술중출혈50～ 1500 ml,평균150 ml.술중발생대출혈4례,수혈1례;술중발생단측폐공신경손상3례,미여특수처리.장공능회복시간24～72 h,평균35 h.류치뇨관시간7 ～14d,평균9d.술후발생문합구루뇨12례,기중술후1d5례、2d3례、3d2례,술후4、5d각1례.술후5d출현하지정맥혈전1례.술후2d출현림파루1례,연장인류시간후자유.술후2～4개월3례발생방광뇨도문합구협착,2례경뇨도확장후증상완해,1례경뇨도경내절개호전.술후병리보고절연양성18례,정낭선침범21례,가혈관림파결양성9례.술후주원시간5～22 d,평균10d.술후96례1년내회복공뇨,11례존재불동정도적뇨실금.술중보류성신경51례,술후2～12개월발기공능회복자33례.술후6주복사혈PSA 0 ～8.75 μg/L,평균0.14μ g/L.술후5～ 36개월,평균18개월48례출현생화복발.결론 eLRP치료고위전렬선암적료효만의,시일충안전가행적치료방식.
Objective To investigate the efficacy and feasibility of extra-peritoneal larparoscopic radical prostatectomy (eLRP) in the treatment of patients with high-risk prostate cancer (HRPC).Methods From February 2009 to December 2013,121 patients,who were diagnosed as HRPC according to the D'Amico definition,were received eLRP.The mean age was 70 years old (range 54 ～ 82 years old).The mean PSA level was 25.45 (range 2.40 ～ 111.31) μg/L and mean Gleason score was 8 (range 6 ～ 10).The classification of clinic stage in this study included 52 cases in cT1-cT2b,58 cases in cT2c,8 cases in cT3a,and 3 cases incT3b,respectively.The perioperative data were collected,including operative time,blood loss,intraoperative complications,urine leakage,lymph leakage,incontinent ability,erectile function and changing of PSA level.Results All the operations were successfully performed.The mean operative time was 165 minutes (range 105 ～341min),the average blood loss was 150 ml(range 50 ～ 1500ml).The intraoperative complications included hemorrhage in 4 cases and intra-operative obturator nerve injury in 3 cases.The mean duration of intestinal function recovery was 35h (range 24 ～72h) The mean interval of catheter indwelling was 9 days (range 7 ～14 days).The anastomotic leakage was found in 12 cases,including 1 day after surgery in 5 cases,2 days after surgery in 3 cases,3 days after surgery in 2 cases,4 day after surgery in 1 case and 5 day after surgery in 1 case.The anastomotic stricture in 3 cases within 2 to 4 months after operation,which the symptom improved after urethral dilation in 2 cases and urethrotomy in 1 case.Deep vein thrombosis was noticed in 1 case 5 days after the procedure.And lymphatic fistula was recorded in 1 case after the operation.Positive surgical margin,seminal vesicle invasion,and positive iliac vessel lymph node were found in 18,21,and 9 patients,respectively.The mean hospitalization duration was 10 days (range 5 ～ 22 d).Of the 107 patients followed-up,Ninety-six patients were continent in 1 year,except other 11 patients.Nerve sparing procedure was performed in 51 patients,and thirty-three of them were potent.The mean PSA level was 0.14 μg/L (range 0 ～8.75 μg/L) six weeks after the surgey.Fourty-eight patients had biochemical recurrence with 5 ～36 months followed-up,mean 18 months.Conclusions Extraperitoneal LRP is an efficacious approach for patients with high-risk prostate cancer.