腹腔镜下解剖性前列腺癌根治术附33例报告

摘要

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.%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。