摘要
目的报道20例腹膜外入路经脐单孔腹腔镜下前列腺癌根治术的中期肿瘤学和功能学随访结果。方法 2009年8月至2011年10月,20例局限性前列腺癌患者接受了单孔腹腔镜下前列腺癌根治术,患者平均年龄66.1岁,平均体重指数24.4 kg/m2,术前平均PSA 12.2 ng/ml。统计分析围手术期、病理、以及术后肿瘤控制、性功能和控尿功能资料。结果所有手术均顺利完成,无需中转常规腹腔镜或开放手术,1例需增加一个5 mm套管。平均手术时间为248 min(190～330 min),平均出血量为94 m(l20～200 ml),无术中并发症发生,术后3 d视觉模拟疼痛评分为1.5分,平均术后住院时间为15.4 d(13～24 d)。病理报告1例(5%)T3a患者切缘阳性,平均Gleason评分6.7分。术后有4例Clavien 2级并发症。平均随访22.8个月(12～36个月),未发现肿瘤生化复发证据,保留双侧勃起神经的患者术后60%恢复了性功能,完全尿控率1年为85%(17/20),2年为90%(9/10),3年为100%(3/3)。结论单孔腹腔镜下前列腺癌根治术技术上可行,不仅美容效果好、术后疼痛轻,且具有令人满意的中期肿瘤控制、性功能和控尿功能保留效果。有必要开展与常规腹腔镜手术的随机对照研究以决定其应用价值。
Objective To report the mid-term oncological and functional outcomes of 20 cases of laparoendoscopic single-site radical prostatectomy（LESS-RP）.Methods Between August 2009 and October 2011,20 LESS-RP procedures were performed in a single center.On average,patients were 66.1 years old,had a mean body mass index of 24.4 kg/m2,and a mean prostate-specific antigen（PSA） value of 12.2 ng/ml.Perioperative,pathologic,mid-term oncological and functional outcomes data were analyzed.Results All procedures were completed without conversion to standard multiport laparoscopy or open surgery.A single additional 5 mm port was required in 1 case.The mean operative time was 248 min and the mean estimated blood loss was 94 ml.The mean visual analog pain score at day 3 was 1.5 out of 10,and the mean hospital stay was 15.4 d.Pathology showed 1 focal positive margin（5%） in a T3a patient,and mean Gleason score was 6.7.There were a total of four Clavien grade 2 complications.The median follow-up was 22.8 months（range： 12-36 months）.No PSA recurrence was detected during follow up period;the potency rate after bilateral neurovascular bundle preservation was 60%（3/5）.The continence rate was 85%（17/20） at 1 yr,90%（9/10） at 2 yrs,and 100%（3/3） at 3 yrs.Conclusions LESS-RP is technically feasible and safe,with excellent cosmesis,low postoperative pain levels,and acceptable mid-term oncological and functional outcomes.Comparative investigation to conventional laparoscopic radical prostatectomy is needed.
出处
《中华腔镜泌尿外科杂志（电子版）》
2013年第4期4-7,共4页
Chinese Journal of Endourology(Electronic Edition)
关键词
前列腺癌
前列腺癌根治术
单孔腹腔镜-内窥镜手术
脐
Prostate cancer
Radical prostatectomy
Laparoendoscopic single-site surgery
Umbilicus
