摘要
目的 探讨筋膜内切除法在腹腔镜下根治性前列腺切除术中的应用.方法 前列腺癌患者23例,平均年龄65岁.术前PSA 4.5～8.6（6.25 ±2.1）ng/ml;临床分期T1 16例、T2 7例;活检组织Gleason评分：5分3例、6分11例、7分9例.有性生活者18例.行腹腔镜下根治性前列腺切除术.不打开盆内筋膜,自前列腺基底部沿前部正中线纵形切开前列腺筋膜,贴前列腺包囊分离前列腺前面、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 23例手术顺利.平均手术时间125（110～170）min.出血量320～1500（550±210）ml,输血3例.平均留置尿管12（9～15）d.术后随访12个月,完全尿控20例（87%）.有轻微压力性尿失禁3例（13%）.18例术前有性生活的患者能充分勃起完成性交13例（72%）.随访期间出现生化复发2例（9%）.结论 腹腔镜下筋膜内切除法剥离前列腺对前列腺周围筋膜、附着于筋膜的神经血管束以及尿道外括约肌损伤小.手术方法可行.
Objective To discuss the treatment efficacy of intrafascial endoscopic extraperitoneal radical prostatectomy（EERPE）in prostate cancer patients. Methods The operation was performed in 23 prostate cancer patients.The mean age was 65 years old.Preoperative prostate-specific antigen（PSA）level was 4.5-8.6（6.2±2.1）ng/ml,and patients distribution as Gleason Score 5 in 3 cases,Gleason Score 6 in 11 cases and Gleason Score 7 in 9 cases.Eighteen patients had preoperative potency.The technique was to keep the endopelvic fascia intact.The prostatic fascia was incised anterior medially from the base of the prostate.And the dissection plane was directly on the prostatic capsule.The bilateral and apex prostate fascia were stripped though this plane without inure the neurovascular bundle and external sphincter.All the 23 patients were followed up for 1 2 months. Results The mean operative time was 125 min（range：110-170 min）.Hemorrhage was 320-1500（550±210）ml.Transfusion rate was 13%.Mean catheterization time was 12 d（range：9-15 d）.At 12months postoperatively,87%of patients were continent（no need for pads）,13%had minimal stress incontinence（1-2 pads）.72%of 1 8 cases who had potency preoperative kept erections sufficient for intercourse with or without the help of PDE5 inhibitors.During the follow-up period,9%（2 cases）had biochemical recurrence. Conclusion The intrafascial EERPE may have limited trauma to the prostate surrounding fascias,the neurovascular bundles and the external sphincter.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2010年第7期482-485,共4页
Chinese Journal of Urology
