摘要
目的分析微创根治性前列腺切除术(MIRP)后行非计划再次手术的原因,并探讨应对策略。方法回顾性分析浙江省人民医院2014年9月至2019年7月收治的4例行MIRP后非计划再次手术患者的临床资料。年龄56~71岁,平均65岁。术前tPSA 5.17~13.20 ng/ml,平均10.12 ng/ml。均行前列腺穿刺活检诊断为前列腺腺癌,Gleason评分3+3分1例,3+4分2例,4+4分1例。病理分期pT2a期2例,pT2b期2例。首次手术方式为腹腔镜手术1例,机器人手术3例;经腹膜外入路1例,经腹腔入路3例。结果再次手术的原因均为出血:动脉性出血3例(分别为精囊动脉、脐动脉、肠系膜动脉),表现为血流动力学不稳定;静脉性出血1例(耻骨后背深静脉复合体),表现为盆腔血肿、吸收热。4例非计划再次手术均由泌尿外科医生在腹腔镜下(经腹腔入路)完成。处理方式:缝扎出血动脉1例,夹闭出血动脉2例,清除盆腔血肿1例。所有病例经再次手术均治愈出院,随访11~48个月,未见生化复发、真性尿失禁等。结论术后出血是导致MIRP后非计划再次手术的主要原因,选择经腹腔入路腹腔镜探查可迅速找到出血原因,止血效果确切并能去除积血,并发症少,安全、有效。
Objective To analyze the main causes for unplanned re-operation of prostatic cancer.Methods The clinical data of 4 patients with prostatic cancer who underwent an unplanned re-operation were analyzed retrospectively between September 2014 and July 2019 in our hospital.Preoperative data of patients was collected as follows:mean age of 65 years,ranged from 56 to 71 years.tPSA ranged from 5.17-13.20 ng/ml.Gleason score of 3+3 in 1 case,3+4 in 2 cases,4+4 in 1 case.pTNM pT2a in 2 Cases,pT2b in 2 cases.LRP(extraperitoneal approach)in 1 case,RARP(transperitoneal approach)in 3 cases.Results The main causes for unplanned re-operation were as follows:perioperative hemodynamic instability(75%,3/4),post-operative fever(25%,1/4).All 4 re-operations were performed by urologists using Laparoscopic exploration of abdomen.Conclusions Inadequate and inappropriate surgical hemostasis are the key to lead a second-look surgery of prostatic cancer.A complete hemostasis could help to lower the re-operation rate.Laparoscopic exploration of abdomen could be one of the choices to deal with re-operation after minimally invasive radical prostatectomy.
作者
沃奇军
祁小龙
刘锋
张琦
毛祖杰
张大宏
Wo Qijun;Qi Xiaolong;Liu Feng;Zhang Qi;Mao Zujie;Zhang Dahong(Department of Urology,Zhejiang Provincial People*5 Hospital,Hangzhou People*s Hospital of Hangzhou Medical College,Hangzhou 3]0014,China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2019年第12期905-908,共4页
Chinese Journal of Urology
关键词
前列腺肿瘤
前列腺切除术
微创
非计划再手术
并发症
Prostatic neoplasms
Prostatectomy
Minimally invasive
Unplanned re-operation
Complications
