摘要
目的探讨腹腔镜技术在高危前列腺癌根治术中应用的可行性和临床疗效。方法 2012年1月～2014年12月腹腔镜下对高危前列腺癌行根治性切除术48例,先行双侧盆腔淋巴结清扫活检,病理检查报告阴性后行前列腺癌根治术。打开膀胱前间隙,靠近前列腺包膜切开盆底筋膜,离断耻骨前列腺韧带,＂8＂字贯穿缝扎阴茎背深静脉复合体,离断膀胱颈部,提起双侧输精管及精囊,打开Denonvillier筋膜,离断前列腺侧韧带,充分游离剪断尿道,重建膀胱颈,并与尿道吻合。结果 47例顺利完成手术,1例因术中输尿管开口损伤而中转开放手术。术后9～14 d拔除导尿管,35例排尿通畅,尿控良好;12例术后早期出现尿失禁,经提肛训练等辅助治疗,拔管后30～90 d恢复控尿。术后病理均为前列腺腺癌,切缘阳性13例,予以辅助内分泌治疗。45例随访6～38个月,总前列腺特异抗原降为0～2.77μg/L,未发现局部复发和远处转移。结论腹腔镜下高危前列腺癌行根治性切除术可行,疗效满意。
Objective To evaluate the feasibility and clinical efficacy of laparoscopic radical prostatectomy for high-risk prostate cancer. Methods From January 2012 to December 2014,48 patients with high-risk prostate cancer underwent laparoscopic radical prostatectomy（ LRP） when pathological results of pelvic lymphadenectomy were negative. Firstly we incised prevesical space and pelvic floor fascia next to the prostate capsule. Then the puboprostatic ligament amputation and bladder neck transaction were conducted,and the retropubic dorsal vein complex was sutured with absorbable sutures. The Denonvillier ligament and prostate lateral ligament were incised to expose the urethra. After the incision of urethra,the reconstructed bladder neck was anastomosed with the urethra. Results Of all the 48 patients,47 patients underwent radical prostatectomy successfully,and 1 patient received a conversion to open operation because of ureteral injury. The catheters were removed within 9- 14 days after the operation. Thirty-five patients had normal urination,while 12 patients suffered from temporary urinary incontinence which became normal after expectant treatment in 30- 90 days after the operation. The postoperative pathological results of all patients confirmed prostate cancer,13 of which had positive margin and underwent adjuvant endocrine therapy. The TPSA levels fell to 0- 2. 77 μg / L,and none of the patients had local recurrence or distant metastasis in follow-ups for 6- 38 months. Conclusion Laparoscopic radical prostatectomy for highrisk prostate cancer is feasible and effective.
出处
《中国微创外科杂志》
CSCD
北大核心
2015年第11期1028-1030,1037,共4页
Chinese Journal of Minimally Invasive Surgery
关键词
前列腺癌根治术
高危
腹腔镜
Radical prostatectomy
High-risk
Laparoscopy
