筋膜内切除法在腹腔镜下前列腺癌根治性切除术中的应用

干思舜; 徐丹枫; 高轶; 崔心刚; 王军凯

筋膜内切除法在腹腔镜下前列腺癌根治性切除术中的应用

- 第二军医大学长征医院泌尿外科, 全军泌尿外科中心(上海, 200003)

详细信息

通讯作者: 徐丹枫,E-mail:xu-danfeng@hotmail.com

中图分类号: R737.25

收稿日期: 2011-11-09

The application of intrafascial laparoscopic extraperitoneal radical prostatectomy in prostate cancer patients

- Department of Urology, Changzheng Hospital, the Second Military Medical University, Shanghai, 200003, China

More Information

Corresponding author: XU Danfeng, E-mail: xu-danfeng@hotmail.com

Received Date: 09 November 2011

摘要

摘要: 目的：探讨筋膜内切除法在腹腔镜下前列腺癌根治性切除术中的应用。方法：自2009年9月~2010年11月采用筋膜内切除法在腹腔镜下行前列腺癌根治性切除术治疗前列腺癌患者19例，年龄51~72岁，平均（61.0±9.2）岁。术前血PSA为4.1~13.2 μg/L，平均（8.6±4.1）μg/L。临床分期T₁12例，T₂7例；活检组织Gleason评分：5分2例，6分10例，7分7例。术中不打开盆内筋膜，自膀胱颈口1点及11点位置纵形切开前列腺筋膜，紧贴前列腺包膜分离前列腺前面、两侧、尖部，保留神经血管束，保护前列腺尖尿道相连处括约肌。结果：19例手术顺利，手术时间55~115（85.0±28.6） min，出血量30~200（120.0±56.4） ml，无输血，留置尿管时间8~14（11.0±2.8） d。术后随访12个月，完全尿控17例（89.5%），有轻微压力性尿失禁2例（10.5%）。16例术前有性生活者，术后能完成性交者14例（87.5%）。随访期间出现生化复发1例（5.3%）。结论：腹腔镜下筋膜内切除法根治性切除前列腺癌对神经血管束以及尿道外括约肌损伤较小，术后尿失禁及勃起功能障碍发生率较低，值得推广。
- 前列腺癌 /
- 前列腺切除术 /
- 腹腔镜术 /
- 前列腺筋膜
Abstract: Objective: To discuss the application of intrafascial laparoscopic extraperitoneal radical prostatectomy in prostate cancer patients.Method: The operation was performed in 19 prostate cancer patients from 2009.09-2010.11 in our hospital. The age was 51-72(61.0±9.2)years old. Preoperative prostate specific antigen(PSA) leve1 was 4.1-13.2(8.6±4.1)μg/L, T₁ clinical stage in 12 patients, T₂ clinical stage in 7 patients,and patients distribution as Gleason Score 5 in 2 cases, Gleason Score 6 in 10 cases and Gleason Score 7 in 7 cases. Sixteen patients had preoperativepotency. The technique was to keep the endopelvic fascia intact. The prostatic fascia was incised at 1 and 11 o'clock points. And the dissection plane was directly on the prostatic capsule. The bilateral and apex prostate fascia were stripped though this plane without injure the neurovascular bundle and external sphincter.Result: The oprative time was 55-115(85.0±28.6) min. Hemorrhage was 30-200(120.0±56.4) ml. No transfusion. Catheterization time was 8-14(11.0±2.8) d. All the 19 patients were followed up for 12 months. 89.5% of patients were continent(no need for pads), 10.5% had minimal stressincontinence (1-2 pads). 87.5% of 16 cases who had potency preoperative kept erections sufficient forintercourse. During the follow up period, 1(5.3%) had biochemical recurrence.Conclusion: The neurovascular bundles and the external sphincter are less injured by intrafascial laparoscopic extraperitoneal radical prostatectomy. Urinary incontinence and erectile dysfunction were low. The operation should be promoted.
- prostatic cancer /
- prostatectomy /
- laparoscopy /
- prostatic fascia

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