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目的总结经腹膜外入路腹腔镜前列腺癌根治术的临床体会。方法回顾性分析2010年10月至2011年12月,采用四孔经腹膜外入路行腹腔镜前列腺癌根治术治疗局限性前列腺癌患者16例的临床资料。结果本组16例手术全部顺利完成,9例同期行盆腔淋巴结清扫术,无一例中转开放。手术时间150～420min,平均270min。术中出血量50～2000ml,平均534ml,4例术中输血400～800ml,输血率25%。术后病理报告切缘阳性1例(6.2%)。术后4～15d出院,平均8d。所有患者留置尿管2周,拔除尿管后无真性尿失禁。随访3～17个月,8例昼夜控尿良好,8例白天偶有压力性尿失禁,其中1例术后4个月出现吻合口狭窄。9例患者术后可勃起,其中1例行保留神经的前列腺癌根治术患者术后1个月可正常进行性生活。结论经腹膜外入路腹腔镜前列腺癌根治术具有创伤小、出血少、操作容易、并发症少等优点,是开展腹腔镜前列腺癌根治术的较好选择。
Objective To summarize the clinical experience of radical retroperitoneal laparoscopic radical prostatectomy. Methods The clinical data of 16 patients with localized prostate cancer undergoing laparoscopic radical prostatectomy using a four-hole extraperitoneal approach were retrospectively analyzed from October 2010 to December 2011. Results The operation of 16 cases in this group was completed successfully, and pelvic lymphadenectomy was performed in 9 cases in the same period. Surgery time 150 ~ 420min, an average of 270min. Intraoperative blood loss of 50 ~ 2000ml, an average of 534ml, 4 cases of intraoperative blood transfusion 400 ~ 800ml, blood transfusion rate of 25%. One case (6.2%) had positive margins after surgery. 4 ~ 15d after discharge, an average of 8d. All patients with indwelling catheter for 2 weeks, no urinary incontinence after removal of the catheter. During the follow-up of 3 to 17 months, 8 patients had good daytime and night control of urinary incontinence, and 8 patients were occasionally stressed urinary incontinence during the daytime. One patient had anastomotic stenosis at 4 months after operation. Nine patients were erectile after surgery, of which 1 case of nerve-preserving prostate cancer radical surgery one month after surgery can be normal sex life. Conclusion The extraperitoneal laparoscopic radical prostatectomy has the advantages of less trauma, less bleeding, easier operation and less complications. It is a better choice for laparoscopic radical prostatectomy.