经腹膜外腹腔镜前列腺癌根治术治疗高危前列腺癌的临床研究（附49例报告）

Laparoscopic radical prostatectomy for high-risk prostate cancer (49 cases)

摘要:

目的  评价经腹膜外腹腔镜前列腺癌根治术治疗高危前列腺癌患者的安全性及疗效。方法  该科自2012年1月-2015年8月对49例高危前列腺癌患者行经腹膜外腹腔镜前列腺癌根治术，术中采用了“三明治”法进行尿道重建。结果  49例手术均获得成功，无中转开放手术。手术时间平均（2.15±0.29）h，术中出血量（60.25±20.29）ml，没有直肠损伤出现。患者术后1或2 d可以下地活动。术后病理显示盆腔淋巴结转移5例，切缘阳性13例。3例患者术后出现轻度尿失禁，2例患者出现尿道狭窄。对其中46例患者随访1～43个月，5例患者出现生化复发。结论  经腹膜外腹腔镜前列腺癌根治术治疗高危前列腺癌安全、有效。熟悉前列腺局部解剖及熟练掌握各种腹腔镜下操作技术是手术成功的关键。

Abstract:

Objective To evaluate the safety and effect of extraperitoneal laparoscopic radical prostatectomy for high-risk prostate cancer. Methods From January 2012 to August 2015, 49 patients diagnosed high-risk prostate cancer underwent extraperitoneal laparoscopic radical prostatectomy with 'sandwich' urethra reconstruction. Results None converted to open surgery and the mean operative time was (2.15±0.29) h, mean intraoperative blood loss was (60.25 ± 20.29) ml. No rectal injury was observed. The patients were ambulant 1 to 2 days postoperatively. Pelvic lymph nodes metastasis was found in 5 cases. Positive margin was found in 13 cases. Mild urinary incontinence occurred in 3 cases. Urethral stenosis occurred in 2 cases. Biochemical relapses occurred on 5 cases during the following period of 1～43 months for 46 cases. Conclusions Extraperitoneal laparoscopic radical prostatectomy is safe and effective in treatment of high-risk prostate cancer. The very key is to master the anatomy of prostate and laparoscopic techniques.