单孔经膀胱腹腔镜下前列腺癌根治术39例临床分析

摘要

目的 探讨单孔经膀胱腹腔镜下前列腺癌根治术的手术技巧和临床疗效.方法 回顾性分析2010年11月至2015年6月中山大学附属第三医院泌尿外科收治的行单孔经膀胱腹腔镜下前列腺癌根治术的39例患者的临床资料.患者年龄47 ～ 70岁,中位年龄[M(QR)]64(10)岁;术前血清总前列腺特异性抗原(PSA)水平4.2～9.8μg/L,中位数为7.9 (2.9)μg/L;临床TNM分期cT1c期24例,cT2a期15例;所有患者穿刺Gleason评分≤6分;国际勃起功能指数评分18 ～24分,平均(21.7±1.6)分.患者在全身麻醉下行单孔经膀胱腹腔镜下前列腺癌根治术,术后定期复查血清PSA,记录术后1、3、6个月时控尿情况及3、6、12个月时勃起功能恢复情况.结果 所有手术顺利完成,无中转常规腹腔镜术式,术中无手术相关并发症.手术时间(105±26) min,术中出血量(100±56)ml,无输血患者.术后病理分期pT2a期30例,pT2b期9例,Gleason评分均≤6分,手术切缘均阴性.术后留置尿管(11.6±1.4)d,住院时间(12.9±4.3)d.术后随访12 ～ 60个月,平均39个月.术后1、3、6个月时控尿率分别为84.6％、97.4％、100％;术后3、6、12个月时勃起功能恢复率分别为48.7％、64.1％、76.9％.随访期间l例出现尿道狭窄,行尿道狭窄切开术后治愈.2例出现生化复发,无生化复发生存率94.9％.结论 单孔经膀胱腹腔镜下前列腺癌根治术治疗低危局限性前列腺癌术后控尿和勃起功能恢复情况满意,并发症少,控瘤效果确切.%Objectives To present the surgical technique of transvesical single-site laparoscopic radical prostatectomy (TVSSLRP) and to evaluate its clinical efficacy.Methods The clinical parameters of 39 patients who underwent transvesical single-site laparoscopic radical prostatectomy in Department of Urology,Third Affiliated Hospital of Sun Yat-Sen University from November 2010 to June 2015 were retrospectively reviewed.The age was (M(QR)) 64 (10) years (range 47 to 70 years).The median preoperative serum total prostate specific antigen (PSA) level was 7.9 (2.9) μg/L (range 4.2 to 9.8 μg/L).The clinical TNM stage comprised 24 cases of cT1c and 15 cases of cT2a.All the transrectal biopsy Gleason score ≤6.The International Index of Erectile Function (IIEF-5) was (21.7 ± 1.6) points (range 18 to 24 points).The surgical procedures were performed through single-site transvesical approach.The postoperative serum PSA was regularly detected.The continence status were recorded at 1st month,3rd month and 6th month after catheter removal,and the potencies were evaluated at 3rd month,6th month and 12th month postoperative,respectively.Results All the operations were successfully performed and there was no intraoperative complication or conversion to standard laparoscopic approach.The operation duration was (105 ± 26) minuetes,the estimated blood loss was (100 ± 56) ml and no blood transfusion was required.The pathological TNM stage comprised 30 cases of pT2a and 9 cases of pT2b,the Gleason score all ≤6 and no patient had positive surgical margins.The duration of urinary catheterization was (11.6 ±1.4) days and hospital stay was (12.9 ±4.3) days.The continence rates were 84.6％,97.4％,100％ at 1st month,3rd month and 6th month after catheter removal,respectively.The potency rates were 48.7％,64.1％,76.9％ at 3rd month,6th month and 12th month postoperative,respectively,with an IIEF-5 score ≥18.Two cases demonstrated biochemical recurrence and one case presented vesico-urethral stricture during an average follow-up of 39 months (range 12 to 60 months).Conclusions TVSSLRP is suitable for lowrisk organ-confined prostate cancer.It can provide satisfactory continence and potency recovery,less complications and good oncological results.