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目的探讨腹腔镜根治性前列腺切除术的疗效。方法回顾性分析2000年3月至2003年8月159例腹腔镜根治性前列腺切除术患者资料。平均年龄58岁(42~74岁),同时行双侧盆腔淋巴结清扫术57例(35.9%)。术前159例患者前列腺活检均确诊为前列腺癌。G leason肿瘤分级:3+3:129例(81.1%),3+4:23例(14.5%),4+3:4例(2.5%),4+4:3例(1.9%)。TNM肿瘤分期:T1 c126例(79.3%),T2 a33例(20.7%)。结果159例患者平均手术时间298 m in(165~660m in)。术中估计失血量平均293 m l(50~2500 m l),发生严重并发症15例(9.4%),其中中转开放手术6例(3.8%),无死亡病例。术后病理确诊为前列腺癌158例,1例诊断为良性前列腺增生伴急性前列腺炎。标本切缘阳性34例(21.5%)。术后1年53例患者获得随访,术前31例(58.5%)有阴茎勃起功能的患者根据国际阴茎勃起功能指数(IIEF-5)评分分组进行术后变化评估。术后IIEF-5评分显著下降,各评分组间的差异无统计学意义。36例(67.9%)可通过使用V iagra等药物进行性生活,6例(11.3%)有尿失禁。结论腹腔镜根治性前列腺切除术是一种相对安全、微创、并发症低、术后康复快,同时又能达到肿瘤治疗效果的手术方法。但长期疗效尚待进一步观察。
Objective To investigate the effect of laparoscopic radical prostatectomy. Methods The data of 159 patients undergoing laparoscopic radical prostatectomy from March 2000 to August 2003 were retrospectively analyzed. The average age was 58 years (range, 42-74 years). Fifty-seven patients (35.9%) had bilateral pelvic lymphadenectomy at the same time. Preoperative 159 patients with prostate biopsy were diagnosed with prostate cancer. G leason tumor grade: 3 + 3: 129 cases (81.1%), 3 + 4: 23 cases (14.5%), 4 + 3: 4 cases (2.5%), 4 + 4: 3 cases (1.9%). TNM tumor staging: T1 c126 cases (79.3%), T2 a33 cases (20.7%). Results The average operation time of 159 patients was 298 mins (165 ~ 660m in). Intraoperative blood loss was estimated to average 293 m l (50-2500 m l) and 15 (9.4%) severe complications occurred, including 6 (3.8%) open surgery and no deaths. Postoperative pathology confirmed 158 cases of prostate cancer, 1 case of benign prostatic hyperplasia with acute prostatitis. The positive margins of specimens were 34 cases (21.5%). Fifty-one patients were followed up one year after operation. 31 cases (58.5%) with erectile function before operation were evaluated according to the International Penile Erectile Function Index (IIEF-5) score. Postoperative IIEF-5 scores decreased significantly, the differences between the various groups were not statistically significant. Thirty-six (67.9%) patients were sexually active with drugs such as Vagagra and 6 (11.3%) had urinary incontinence. Conclusion Laparoscopic radical prostatectomy is a relatively safe, minimally invasive, low complication, rapid postoperative recovery, at the same time can achieve the effect of surgical treatment of the tumor. However, long-term efficacy remains to be further observed.