CAJ | 학술논문

目的：探讨腹腔镜下解剖性前列腺癌根治术的手术技巧及临床效果。方法33例患者按既定手术步骤施行解剖性前列腺癌根治术。4孔法建立腹膜外空间,以髂外血管、闭孔神经为标志清扫淋巴结；以耻骨弓、盆内筋膜等为标志游离前列腺腹侧；以前列腺耻骨韧带、尿道为标志缝扎阴茎背深静脉复合体；以输精管、Denonvillier筋膜等为标志游离前列腺背侧；以前列腺包膜为标志处理两侧血管蒂,最后单针连续吻合膀胱颈与尿道完成手术。结果33例患者手术均获成功。手术时间60~200min,平均100min；术中出血量50~400mL,平均110mL,均未输血；术后留置尿管10~18d,平均13d。拔除尿管后3例轻度尿失禁,经提肛训练8周后缓解。术后1~3月复查PSA均小于0．2ng/mL,随访超声及影像学检查未发现复发和远处转移。结论腹腔镜下解剖性前列腺癌根治术步骤明确,解剖层次清晰,效果确切,值得推广应用。
목적：탐토복강경하해부성전렬선암근치술적수술기교급림상효과。방법33례환자안기정수술보취시행해부성전렬선암근치술。4공법건립복막외공간,이가외혈관、폐공신경위표지청소림파결；이치골궁、분내근막등위표지유리전렬선복측；이전렬선치골인대、뇨도위표지봉찰음경배심정맥복합체；이수정관、Denonvillier근막등위표지유리전렬선배측；이전렬선포막위표지처리량측혈관체,최후단침련속문합방광경여뇨도완성수술。결과33례환자수술균획성공。수술시간60~200min,평균100min；술중출혈량50~400mL,평균110mL,균미수혈；술후류치뇨관10~18d,평균13d。발제뇨관후3례경도뇨실금,경제항훈련8주후완해。술후1~3월복사PSA균소우0．2ng/mL,수방초성급영상학검사미발현복발화원처전이。결론복강경하해부성전렬선암근치술보취명학,해부층차청석,효과학절,치득추엄응용。
Objective This paper is to discuss the operative skill and clinical effect of laparoscopic radical prostatectomy. Methods The anatomic radical prostatectomy was applied on 33 patients according to the established surgical procedures. The extra-peritoneal space was established with the four-hole method,and the lymph node was dissected with the external iliac blood vessels and the nervi obturatorius as the marks,the ventral prostate was dissociated with the arcus pubis and the fascia pelvis etc. As the marks,the deep dorsal vein complex of penis was sutured with the prostatic ligament and the urethra as the marks,the dorsal prostate was dissociated with the seminiferous duct and the Denonvillier fascia etc. As the marks,the bilateral vessel pedicles were treated with the prostatic capsule as the mark;Finally,the single needle running suture method was applied for urethrovesical anas-tomosis,and the surgery was completed. Results Operations on 33 patients were all successful. Operation time:60min-200min, 100min on average. Intraoperative bleeding:50mL~400mL,110mL on average,no blood transfusion for all patients. Postoperation catheters were indwelled for 10-18 days,13 days on average. After the ureter was removed,light incontinentia urinae happened to three patients,but was relieved after they did the anus-lifting exercise for 8 weeks. In there-examination 1-3 months after the opera-tion,PSA of every patient was less than 0. 2ng/mL. No palindromia or distant metastasis was found during the follow-up ultrasonic and iconographical examination. Conclusion The laparoscopic anatomic radical prostatectomy has definite procedures,clear ana-tomical layers and exact effect,so it is worthy spreading and applying.