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目的 :探讨根治性膀胱前列腺切除术中控制膀胱侧韧带和前列腺背静脉丛损伤出血的方法。方法 :对14例男性膀胱癌患者施行根治性膀胱前列腺切除术 ,术中运用了顺行、逆行相结合方法控制侧韧带切除膀胱 ,连续缝合完成背静脉丛的结扎切断后切除前列腺。结果:14例手术均顺利完成。术中膀胱侧韧带及背静脉丛损伤出血得到了有效控制 ,出血量明显减少 ,平均 4 0 0 ml;手术时间缩短 ,平均 85 min。术后无并发症发生。平均随访 18个月 ,1例局部肿瘤复发 ,其余患者无瘤存活。 结论:合理地控制膀胱侧韧带、结扎后切断前列腺背静脉丛对提高根治性膀胱前列腺切除术的安全性和普及性有重要作用 ,同时为原位肠代膀胱术提供了良好的手术平台。
Objective: To explore the method of controlling the hemorrhage of bladder ligament and prostatic venous plexus during radical prostatectomy. Methods: A total of 14 patients with bladder cancer undergoing radical prostatectomy underwent radical resection of the prostate by ligating both sides of the ligaments. Results: All 14 cases were successfully completed. The intraoperative side of the bladder ligaments and venous plexus injury hemorrhage has been effectively controlled, the amount of bleeding was significantly reduced, with an average of 400 ml; operation time shortened, an average of 85 min. No postoperative complications. The average follow-up of 18 months, 1 case of local tumor recurrence, the remaining patients without tumor survival. Conclusion: The reasonable control of the bladder ligament and the ligation of the prostatic venous plexus can play an important role in improving the safety and universality of radical prostatectomy. At the same time, it provides a good surgical platform for the treatment of orthotopic bladder debridement.