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目的采用经膀胱单孔腹腔镜下前列腺剜除术治疗前列腺增生,总结初步治疗经验和体会。方法 11例前列腺增生患者,年龄67～80岁,平均(72.3±4.61)岁,体质指数18～29kg/m2,平均(22±3.81)kg/m2;超声测量前列腺体积19.9～116.9ml,平均(74.3±27.9)ml;IPSS评分20～35分,平均(27.1±4.89)分;残余尿量18～1 000ml,平均(308.3±283.6)ml;6例术前最大尿流率3.5～15.7ml/s,平均(8.42±4.09)ml/s,4例因急性尿潴留留置导尿及1例因梗阻性肾衰未行尿流率检测;术前PSA水平2.31～12.15ng/ml,平均(6.41±2.89)ng/ml,PSA>4ng/ml的6例患者术前穿刺结果均为良性前列腺增生。麻醉成功后,于脐下做2cm皮肤切口,切开白线,上推腹膜,显露膀胱顶部,在膀胱镜监视下,放置单孔多通道套件,撤出膀胱镜,连接气腹机建立气膀胱空间。置入5mm一体式腹腔镜,以可弯剪刀沿外科包膜内缘游离并剜除增生前列腺组织,经单孔套件取出。缝合膀胱裂孔后,留置导尿,并留置耻骨后引流管自切口引出。结果 1例因放置单孔套件失败,中转开放行耻骨上前列腺剜除术。其余10例手术顺利完成,耗时120～210min,平均(155±30.1)min,术中出血50～900ml,平均(355±288.1)ml,仅1例术中输血1 200ml,无其他严重并发症。10例单孔腹腔镜下切除组织12～76ml,平均(36.8±20.2)ml,术后病理均为良性前列腺增生。术后膀胱冲洗2～4d,平均(2.7±0.95)d,术后1～4d拔除耻骨后引流管,平均(2.4±0.92)d,术后住院5～11d,平均(7.1±1.73)d,2周拔除导尿管。术后随访1～3个月,最大尿流率为16.4～26.9ml/s,平均(23.2±5.59)ml/s,残余尿量10～67ml,平均(38.3±13.7)ml,IPSS评分为1～4分,平均(2.1±0.86)分,排尿均正常,无尿失禁、尿潴留、排尿困难等其他并发症。结论单中心的初步经验表明,经膀胱单孔腹腔镜前列腺剜除术安全、有效、可行,且创伤小,但确切疗效需大样本随机对照研究和长期随访观察。
Objective To study the treatment of benign prostatic hyperplasia by single-hole laparoscopic prostatectomy, summarize the initial treatment experience and experience. Methods Eleven patients with benign prostatic hyperplasia (mean age: 72-80 years old, mean age: 72.3 ± 4.61 years, body mass index: 18-29 kg / m2, averaged 22 ± 3.81 kg / m2) 74.3 ± 27.9) ml; the IPSS score was 20-35, with an average of (27.1 ± 4.89) points; the residual urine volume was 18-1 000ml, with an average of (308.3 ± 283.6) s, with an average of (8.42 ± 4.09) ml / s, 4 cases of urinary retention catheterization due to acute urinary retention and 1 case of obstructive renal failure without urinary flow rate. Preoperative PSA levels ranged from 2.31 to 12.15 ng / ml, ± 2.89) ng / ml, PSA> 4ng / ml of 6 patients preoperative puncture results are benign prostatic hyperplasia. After anesthesia success, under the umbilicus to do 2cm skin incision, incision white line, push the peritoneum, revealed the top of the bladder, under the surveillance of cystoscopy, single-hole multi-channel kit, withdrawal of cystoscopy, pneumoperitoneum connected to establish the bladder space. Into 5 mm integrated laparoscopic surgery with a flexible scissors along the inner edge of the free edge and remove the proliferation of prostate tissue, the single-hole kit removed. Stitching bladder cleft, indwelling catheterization, and left after the pubis drainage tube lead from the incision. Results One case was failed due to the placement of the single-hole kit, and the transfer was performed on the suprapubic prostatectomy. The other 10 cases were successfully completed and took 120 ~ 210min, mean (155 ± 30.1) min, intraoperative bleeding 50 ~ 900ml, average (355 ± 288.1) ml, only 1 case intraoperative blood transfusion 1 200ml, no other serious complications . Ten cases of single-hole laparoscopic resection tissue 12 ~ 76ml, an average of (36.8 ± 20.2) ml, postoperative pathology are benign prostatic hyperplasia. Postoperative bladder irrigation was performed for 2 to 4 days, with an average of (2.7 ± 0.95) d. The retropubic drainage tube was removed from 1 to 4 days after operation, with an average of (2.4 ± 0.92) d and hospitalization for 5 to 11 days (mean, 7.1 ± 1.73) Remove the catheter 2 weeks. The maximum uroflow rate was 16.4-26.9ml / s (mean, 23.2 ± 5.59ml / s), the residual urine volume was 10-67ml (mean, 38.3 ± 13.7) ml and the IPSS score was 1 ~ 4 points, mean (2.1 ± 0.86) points, urination were normal, no incontinence, urinary retention, dysuria and other complications. Conclusion The preliminary experience of the single center shows that the single hole laparoscopic prostatectomy is safe, effective and feasible and the trauma is small. However, the exact curative effect needs large sample randomized controlled study and long-term follow-up observation.