摘要
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.Gleason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:T1c126例(79.3%),T2a 33例(20.7%).结果 159例患者平均手术时间298 min(165～660min).术中估计失血量平均293 ml(50～2500 ml),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Viagra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 evaluate the efficacy of laparoscopic radical prostatectomy in patients with prostate cancer. Methods The clinical data of 159 patients who underwent laparoscopic radical prostatectomy from March 2000 to August 2003 were reviewed. The patients＇ mean age was 58 years （range,42 -74 years）. Bilateral pelvic lymph node dissection was performed simultaneously in 57 cases （35.9%）. All the cases had pathological diagnosis of prostate cancer by preoperative biopsy. Biopsy results showed Gleason grade 3 ＋3 tumor in 129 cases （81.1%） ,3 ＋4 in 23 cases （14.5%） ,4 ＋3 in4 cases （2.5%） and4 ＋4 in 3 cases （ 1. 9% ）. TNM staging showed Tlo stage tumor in 126 cases （79. 3% ）, T2, in 33 cases （20.7%）. Results The mean skin-to-skin operative time was 298 min （range,165 -660 min） and estimated blood loss was 293 ml （range,50 -2500 ml）. Intraoperative severe complications occurred in 15 cases （9.4%） ,of whom 6 cases （3.8%） underwent conversion to an open surgery. No patient died intraoperatively. Of the 159 cases, 158 were pathologically diagnosed as prostate cancer and 1 case was diagnosed as benign hyperplasia of prostate with acute prostatitis postoperatively. The specimens from 34 cases （21.5%） in 158 cases of prostate cancer had positive margins. The first 53 cases of the cohort had 1-year follow-up postopera- tively. Among them, 31 cases （58.5%） who had erectile function were divided into 3 groups based on the international index of erectile function （ IIEF-5 ） for the evaluation of the postoperative erectile function. Postoperative IIEF-5 scores were significantly decreased, but the difference between groups was not significant. Of the 53 cases ,36 （67.9%） could have intercourse by the use of medications such as Viagra ,Caverject or MUSE. Urinary incontinence occurred in 6 cases （ 11.3% ）. Conclusions These results suggest that laparoscopic radical prostatectomy is a relatively safe, minimally invasive surgery with low morbidity and rapid recovery,and has favorable postoperative quality of life outcomes. The laparoscopic approach can maintain the oncological control of open surgery with added benefits for the patient. However, long-term cancer control and functional results need further investigation.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2005年第12期816-819,共4页
Chinese Journal of Urology
