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目的:总结经腹膜外腹腔镜前列腺癌根治术治疗前列腺癌的手术经验和操作技巧。方法:2006年1月～2010年3月对33例前列腺癌患者行经腹膜外腹腔镜前列腺癌根治术,手术经腹膜外顺行路径切除前列腺,切开膀胱颈部前先以1-0可吸收线缝扎背血管复合体,采用单针连续吻合法进行膀胱与尿道的吻合。结果:33例手术均获得成功,无中转开放手术。手术时间120～575 min,平均234 min,术中出血量100～1 500 ml,平均320 ml,术后48小时内胃肠功能恢复,术后1～2天下地活动,没有直肠损伤和吻合口尿漏出现。标本切缘阳性1例。2例术后出现轻度尿失禁。2例出现尿道狭窄。对其中31例患者随访3～51个月,未发现肿瘤局部和生化复发和远处转移;术后3个月前列腺特异性抗原0～0.1μg/L。结论:经腹膜外腹腔镜前列腺癌根治术是一种安全有效的手术方法。熟悉前列腺局部解剖及熟练掌握各种腹腔镜下操作技术是手术成功的关键。
Objective: To summarize the surgical experience and operation skills of extraperitoneal laparoscopic radical prostatectomy for prostate cancer. Methods: From January 2006 to March 2010, 33 patients with prostate cancer underwent radical retroperitoneal laparoscopic radical prostatectomy. The prostate was removed by extraperitoneal cistern pathology. The bladder neck was excised with 1-0 before incision Suture the dorsal vascular complex, the use of single needle continuous anastomosis urinary bladder anastomosis. Results: All the 33 surgeries were successful. There was no transfer to open surgery. The operation time ranged from 120 to 575 minutes with an average of 234 minutes. The intraoperative blood loss ranged from 100 to 1,500 ml with an average of 320 ml. The gastrointestinal function recovered within 48 hours after operation and ranged from 1 to 2 days after operation. There was no rectal injury and anastomosis Urine leakage appears. The specimen was positive in 1 case. 2 cases of postoperative mild urinary incontinence. 2 cases of urethral stricture. Totally 31 patients were followed up for 3 ~ 51 months. No local or biochemical recurrence and distant metastasis were observed. Prostate specific antigen 0 ~ 0.1μg / L at 3 months after operation. Conclusion: Extraperitoneal laparoscopic radical prostatectomy is a safe and effective surgical method. Familiar with the local anatomy of the prostate and master a variety of laparoscopic operation technique is the key to successful operation.