论文部分内容阅读
目的介绍免结扎血管筋膜复合体技术在腹腔镜根治性前列腺切除术中的应用。方法 2009年12月～2011年9月32例前列腺癌患者接受腹腔镜根治性前列腺切除术。术中采用免结扎(ligationfree)技术处理血管筋膜复合体(DVC),记录术中出血量和手术时间,观察术后出血量、术后导尿管留置时间、前列腺尖部切缘阳性率。术后进行随访。结果所有患者采用免缝扎技术处理DVC均获得满意的止血效果。此步骤手术时间为10～25min,平均13.1min,此步骤手术出血量为10～100mL。所有病例前列腺尖部切缘阴性。术后2～3周拔除尿管,17例患者拔除尿管后1周内排尿即完全可控,所有患者无永久性尿失禁发生。术后随访未发现肿瘤复发和远处转移。结论 DVC的完整对于尿控起到重要的作用,DVC免结扎技术能够清晰暴露前列腺尖部,保留尽可能长的功能尿道,有助于腹腔镜根治性前列腺切除术术后尿控的恢复,可以减少手术时间,并不明显增加术中出血量。
Objective To introduce the application of ligation-free vascular fascia complex in laparoscopic radical prostatectomy. Methods From December 2009 to September 2011, 32 patients with prostate cancer underwent laparoscopic radical prostatectomy. Vascular fascia complex (DVC) was treated by ligation technique during operation. Intraoperative blood loss and operation time were recorded. Postoperative blood loss, postoperative urinary catheter indwelling time, positive rate of prostatic anterior margin were recorded. Postoperative follow-up. Results All the patients received satisfactory hemostatic effect by using the technique of free suture to treat DVC. This step of operation time is 10 ~ 25min, an average of 13.1min, the amount of surgical bleeding in this step was 10 ~ 100mL. All cases of prostate apical negative margin. Urine was removed 2 to 3 weeks after operation. Urination was completely controlled within 1 week after removal of the catheter in 17 patients. No permanent urinary incontinence occurred in all patients. No follow-up of tumor recurrence and distant metastasis was found. Conclusions The completeness of DVC plays an important role in urinary control. The DVC-free ligation technique can clearly expose the prostatic apex, preserve the functional urethra as long as possible, and facilitate the recovery of urinary control after laparoscopic radical prostatectomy. Reduce the operation time, does not significantly increase the amount of intraoperative bleeding.