前列腺电切术后的腹膜外腹腔镜下前列腺癌根治术（附18例报告）

摘要

Objective To describe our experiences on extraperitoneal laparoscopic radical prostatectomy(ELRP) for patients treated with transurethral resection of prostate (TURP) previously. Methods The clinical data of 18 patients who underwent ELRP after previous TURP between December 2006 and October 2012 at our hospital were retrospectively analyzed. All patients were followed-up about 2~72 months. Patients’ mean blood loss, mean catheterization time, complications, functional and oncologic outcome were comparatively reviewed. Results Lymphadenectomy was performed for all patients during operation .Mean blood loss was (328±102)ml, mean catheterization time was (12.4±8.7)days. No case had PSM. No tumor recurrence and distant metastasis occurred.Four patients needed 1~2 pads per day after operation and the others were of urinary continence. 31%of patients reported the ability to engage in sexual intercourse after operation. Conclusion ELRP is an effective treatment for patients with prostate cancer who underwent previous TURP. It can be safely performed without compromising functional and oncology results. ELRP for patients treated with previous TURP is more difficult in technical performing than for patients withno TURP treatment.%　　目的介绍对于经尿道前列腺电切术后（TURP）病理确诊为前列腺癌的患者，采用腹膜外腹腔镜下前列腺癌根治术（ELRP）治疗的经验。方法回顾性分析2006年12月至2012年10月18例TURP后在我科接受ELRP患者的临床资料。患者随访时间为2~72个月，分析术中出血量、术后尿管平均留置时间、并发症、尿控及肿瘤控制情况。结果所有病例术中均行淋巴结清扫。术中平均出血量为（328±102）ml，术后尿管平均留置时间为（12.4±8.7）d。所有病例前列腺切缘均为阴性。术后随访未发现肿瘤复发和远处转移。4例患者术后每日需使用1~2块尿垫，其余患者排尿可控，无需尿垫。术后性功能恢复率约为31%。结论 ELRP是治疗TURP术后的前列腺癌患者有效安全的手术方法。术后患者的肿瘤根治效果及尿控情况满意。TURP术后造成的炎性反应和组织粘连将会增加ELRP的手术难度。