三孔法腹膜外腹腔镜前列腺癌根治术初步经验总结（附24例报告）

doi:10.19558/j.cnki.10-1020/r.2020.04.009

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摘要 目的: 探讨三孔法腹膜外腹腔镜前列腺癌根治术的手术要点及临床应用价值。方法: 回顾性分析2016年1月–2019年6月进行三孔法腹膜外腹腔镜前列腺癌根治术的24例患者的临床资料。患者平均年龄（69.2±5.2）岁,术前平均总前列腺特异抗原（22.0±25.2）μg/L,术前Gleason评分≤6分9例,7分11例,8分3例,9分1例。选择经腹膜外途径分别于脐下2 cm、左右腹直肌外侧缘分别置入10 mm、5 mm及10 mm套管,建立气腹后,先行前列腺切除术,再用3-0 5/8弧倒刺线连续吻合尿道与膀胱颈,最后将膀胱颈口的前壁与阴茎背深静脉复合体缝合固定。术后随访并分析手术时间、术中出血量、围手术期并发症、标本切缘阳性率、术后血清前列腺特异性抗原(PSA)值变化和控尿恢复时间等情况。结果: 24例三孔法腹膜外腹腔镜前列腺癌根治术均获成功,无中转开放。平均手术时间（148.0±49.3）min;平均出血量（156.8±158.9）mL,术中术后均未输血。术后3例患者手术切缘阳性。术后3个月20例患者基本恢复自主控尿,术后6个月24例患者均恢复自主尿控。术后平均随访24（6~48）个月。术后切缘阳性患者及病理为中高危前列腺癌患者行持续内分泌治疗。术后1例发生膀胱结石并行碎石术。2例患者进展为去势抵抗性前列腺癌。结论: 三孔法腹膜外腹腔镜前列腺癌根治术安全可行,但手术显露有一定难度,需手术者精细解剖。

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	李建昌
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	陈锦延

关键词 ：前列腺癌, 根治性前列腺切除术, 腹腔镜, 腹膜外途径

Abstract：Objective: To investigate the operative points and clinical value of extraperitoneal laparoscopic radical resection of prostate cancer by three-hole method. Methods: The clinical data of 24 patients who underwent three-hole extraperitoneal laparoscopic radical prostatectomy in our hospital from January 2016 to June 2019 were retrospectively analyzed. The patients (aged 69.2±5.2 years, preoperative total prostate specific antigen 22.0±25.2 g/L) included 9 cases at ≤ 6 points, 11 cases at 7 points, 3 cases at 8 points, and 1 case in 9 points in preoperative Gleason score. The pneumoperitoneum was established by placing 10 mm, 5 mm and 10 mm cannula at 2 cm below the umbilicus and at the lateral margin of the right and left rectus abdominis through the outer peritoneal approach. The prostatectomy was performed, urethra and bladder neck were successively anastomosed with 3-0 5/8 arc barbed line, and then the anterior wall of the bladder neck was sutured and fixed with the deep vein complex of the penile dorsal. Postoperative follow-up was conducted to analyze the operative time, the intraoperative blood loss, the perioperative complications, the positive rate of specimen margin, the change of serum prostate-specific antigen (PSA) value, and the recovery time of urine control. Results: All 24 cases of extraperitoneal laparoscopic radical resection of prostate cancer by three-hole method were successful, and there was no convention to open surgery. The median operative time and median blood loss were (148.0±49.3) min and (156.8±158.9) mL, respectively, and no blood transfusion was performed intraoperatively and postoperatively. Postoperative surgical margins were positive in 3 patients. Twenty patients basically recovered from master urine control 3 months after the operation, and 24 patients recovered from autonomic urine control 6 months after the operation. At an average of 24 (6-48) months of postoperative follow-up, patients with positive surgical margins and those with medium-high risk of prostate cancer were treated with continuous endocrine therapy. Postoperative bladder calculi occurred in 1 case with lithotripsy, and as of press time, 2 patients had advanced castration-resistant prostate cancer. Conclusion: Three-hole extraperitoneal laparoscopic radical prostatectomy is safe and feasible for prostate cancer, but it is difficult to reveal the operative field of vision, which requires careful dissection.

Key words： prostatic neoplasms radical prostatectomy laparoscopy extraperitoneal approach

收稿日期: 2020-02-12

基金资助:广东省医学科学技术研究基金(A2019319)

通讯作者: 李建昌,13553458141@163.com

引用本文:

李建昌, 柳建军, 陈锦延. 三孔法腹膜外腹腔镜前列腺癌根治术初步经验总结（附24例报告）[J]. 微创泌尿外科杂志, 2020, 9(4): 255-259.
LI Jianchang, LIU Jianjun, CHEN Jinyan. Preliminary experience of three-port extraperitoneal laparoscopic radical prostatectomy (report of 24 cases). JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2020, 9(4): 255-259.

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