摘要
目的探讨改良经腹膜外腹腔镜Vattikuti泌尿所根治性前列腺切除术(VIP)的技术要点、术后初期随访结果及初步经验。方法回顾性分析2017年11月至2018年9月北京大学第一医院收治的46例前列腺癌患者的临床资料。年龄54~77岁,平均65.5岁。术前PSA 0.15~69.76 ng/ml,平均13.40 ng/ml。术前Gleason评分6~10分,平均7.5分。术前临床分期T1c期1例,T2a期5例,T2b期2例,T2c期17例,T3a期8例,T3b期13例。46例均全麻下行改良经腹膜外途径腹腔镜VIP术。本术式改良之处:①建立腹膜外腔后,首先显露、游离、离断膀胱颈部;②处理前列腺尖部时,紧贴尖部包膜用超声刀离断背深静脉丛浅、深层而不做游离缝扎。记录手术时间、术中出血量、术后住院时间、病理分期、术后Gleason评分、术后PSA、尿控恢复时间等指标。结果本组46例手术均顺利完成,无中转开放手术。手术时间69~143 min,平均95.7 min。术中出血量20~200 ml,平均81.5 ml。耻骨后引流管拔除时间3~17 d,平均4.3 d。术后住院时间3~17 d,平均5.3 d。术后14 d拔除导尿管。术后5例出现漏尿,经保守治疗痊愈。术后病理分期:pT2a期1例,pT2c期12例,pT3a期12例,pT3b期21例。术后Gleason评分6~9分,平均7.7分。术后随访时间1~11个月,平均6.3个月。术后1个月PSA 0.001~0.966 ng/ml,平均0.181 ng/ml。术后1个月和3个月控尿率分别为54%(25/46)和89%(34/38)。结论改良经腹膜外腹腔镜VIP术是治疗前列腺癌安全可行的手术方式,其手术步骤简化,不游离缝扎DVC,不增加出血量;可保留前列腺尖部周围组织结构,术后尿控功能恢复快,但患者肿瘤学预后尚待进一步评估。
Objective To investigate the operating key steps and the initial experience of IUPU(Institute of Urology,Peking University)modified extraperitoneal laparoscopic VIP(Vattikuti institute prostatectomy)technique and the initial follow-up outcomes.Methods 46 patients of prostate cancer underwent the modified extraperitoneal laparoscopic VIP and were reviewed from November 2017 to September 2018.Patients aged 54 to 77 years,with mean age of 65.5 years old.Their preoperative PSA was 0.15 to 69.76 ng/ml with an average of 13.4 ng/ml.All patients were diagnosed by prostate biopsy and Gleason score was 6 to 10 with an average of 7.5.MRI was used to assess their clinical stage before operation.All the modified laparoscopic VIP were done through the extraperitoneal approach by a single surgeon and the follow-up by telephone for the PSA level and continence recovery(urine pad test).The major differences between modified laparoscopic VIP and the routine steps of radical prostatectomy are as follows:use of extraperitoneal approach and traditional laparoscopic operation;after the setup of the extraperitoneal cavity,the bladder neck is separated,isolated and cut down first;the management of DVC:Cut down the super-facial and deep layers of DVC just along the capsule of the prostate apex and it’s unnecessary to suture it.Perioperative data of these patients were collected retrospectively,including operation time,intraoperative blood loss,length of hospital stay,postoperative pathology,and continence outcome after surgery.Result All 46 patients underwent the IUPU modified extraperitoneal laparoscopic VIP successfully without converting to open surgery.The operation time was 69-143 min with an average of 95.7 min and the estimated blood loss was 20-200 ml with an average of 81.5 ml.It was 3-17 days for the average time to remove the retropubic drainage tube postoperatively,with an average of 4.3 days.The postoperative hospital stay was 3-17 days with an average of 5.3 days.The Foley catheter was removed 14 days postoperatively.Five patients suffered from urine leakage and were managed successfully with conservative treatment.For the postoperative pathological stage,1 patient was pT2a,12 patients were pT2c,12 patients were pT3a and 21 patients were pT3b.The postoperative Gleason score was 6-9 with an average of 7.7.The postoperative follow-up time was 1-11 months with an average of 6.3 months.The PSA was 0.001-0.966 ng/ml with an average of 0.181 ng/ml 1 month postoperatively and the continence rate was 54%(25/46)and 89%(34/38)1 month and 3 months after operation respectively.Conclusions The IUPU modified extraperitoneal laparoscopic VIP might be a safe and feasible for the radical prostatectomy.It’s simplified for the operative steps,unnecessary to isolate and suture DVC and doesn’t increase the blood loss.It’s almost left intact for the surrounding tissues of the prostate apex and satisfactory for the early urinary continence.The oncological outcomes are needed to followup further.
作者
程嗣达
洪鹏
张雷
唐琦
郝瀚
李学松
周利群
Cheng Sida;Hong Peng;Zhang Lei;Tang Q i;Hao Han;Li Xuesong;Zhou Liqun(Department of Urology,Peking University First Hospital,Institute of Urology,Peking University,National Urological Cancer CenteryBeijing 100034.China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2019年第12期901-904,共4页
Chinese Journal of Urology
