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1、上海医学2010年第33卷第3期·231··专题研究·腹膜外途径腹腔镜下前列腺癌根治术夏国伟孙传玉徐可丁强【摘要】目的探讨腹膜外途径腹腔镜前列腺癌根治术的临床效果。方法前列腺癌患者82例,年龄为60～75岁,中位年龄为68岁。前列腺特异性抗原(PSA)为0.7～23.6ng/mL。TNM分期为T1N0M011例,T2N0M066例,T3aN0M05例。所有患者均于术前行前列腺穿刺活组织检查,或前列腺电切术后经病理检查证实为前列腺癌,均行腹膜外途径腹腔镜前列腺癌根治术。结果82例患者均顺利完成手术,手术时间为150～380min,平均为(210±85)min;术中出血量为400～12
2、00mL,平均为(600±230)mL,出血量>500mL者给予输红细胞悬液200～800mL。术后病理检查结果显示肿瘤切缘为阳性的3例患者术后加用全雄激素阻断治疗3个月。所有患者均于术后2周拔除导尿管,3例术后出现轻度尿失禁的患者经提肛训练等辅助治疗3个月后好转,能自主排尿。术后随访45例,随访时间为3～24个月,中位随访时间为16个月;术后3个月时PSA为0.02～0.10ng/mL,平均为(0.040±0.016)ng/mL。其中局部复发2例,采用辅助内分泌治疗或近距离放射治疗后控制;生化复发26例,采用辅助内分泌治疗控制。结论腹膜外途径腹腔镜下前列腺癌根治术安全、有效。【关
3、键词】腹腔镜;腹膜外途径;前列腺癌根治术ExtraperitoneallaparoscopicradicalprostatectomyforprostatecancerXIAGuowei,SUNChuanyu,XUKe,DINGQiang.DepartmentofUrology,HuashanHospital,FudanUniversity,Shanghai200040,China【Abstract】ObjectiveToevaluatetheclinicalefficacyofextraperitoneallaparoscopicradicalprostatectomyforpr
4、ostatecaneer.MethodsEighty2twopatientswithprostatecancer,aged60-75years(mean,68years),wereincludedinthepresentstudy.Theprostate2specificantigen(PSA)levelranged0.7-23.6ng/mL.TNMclassificationshowedTlN0M0tumorin11cases,T2N0M0tumorin66andT3aN0M0tumorin5.Allcasesunderwentextraperitoneallaparoscopi
5、cradicalprostatectomy.Thefunctionalreconstructivetechniquewasperformedduringtheprocedure,whichconsistingofpreservationoftheurethralandbladderoutletsphinctermusclesandreconstructionofthebladderneck.ResultsTheoperationwassuccessfulinallthe82patients.Theoperativetimewas150-380min(mean[210±85]min)
6、,andthebloodlosswas400-1200mL(mean,[600±230]mL).Allthecatheterswereremoved2weeksaftersurgery.Mildurinaryincontinencewasnoticedoccurredin3cases,anditwasimprovedaftersupportivetreatment.Forty2fivecaseswerefollowedupfor3-24months(mean16months)afteroperation.ThreemonthsafteroperationthePSAlevelwas
7、0.02-0.10ng/mL(mean[0.040±0.016]ng/mL).Twocaseswithlocalrecurrencereceivedadjuvantendocrinetherapyorbrachytherapy,and26caseswithbiochemicalrecurrencereceivedadjuvantendocrinetherapy.ConclusionExtraperitoneallaparoscopicradicalprostatect
