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目的 探讨腹腔镜改良前列腺癌根治术 (LRP)治疗早期前列腺癌的疗效。 方法 2000年 10月至 2004年 9月,对 54例TNM分期为T1b~T2 的前列腺癌患者行经腹途径LRP。前期 15例(A组)按Monstouris法完成手术;后期 39例(B组)在熟悉LRP基本技术后进行技术改良:结扎耻骨后血管复合体,沿前列腺包膜锐性分离前列腺尖部,保留尿道括约肌和尿道直肠肌; 正确判断前列腺与膀胱颈交界部,保护膀胱颈环状肌环;横行离断膀胱颈后唇,在狄氏筋膜和膀胱肌外层之间向膀胱颈近端方向适当游离膀胱颈后唇;精细吻合后尿道与膀胱颈,将吻合口的前壁与耻骨后血管复合体固定。比较两组手术时间、出血量、围手术期并发症、术后控尿恢复时间和血清前列腺特异性抗原(PSA)值。 结果 54例手术均获成功。A、B两组平均手术时间分别为 390(270 ~660)min和 240(180~360)min; 平均出血量 430 ( 200 ~1100 )ml和 160 ( 100 ~400 )ml;手术并发症分别为 6例和5例;恢复控尿时间分别为 6个月和 3个月。以上指标两组比较差异均有统计学意义(P<0. 05)。血清前列腺特异性抗原(PSA)值A组 2例升高,B组随访 33例 1例升高 ( 6例近期完成手术者未复查),其余患者PSA均<0. 1ng/ml。 结论 随着手术技术的熟练和控尿技术的应用,LRP手术时间可缩短至 3h,恢复控
Objective To investigate the effect of laparoscopic modified radical prostatectomy (LRP) on early stage prostate cancer. Methods From October 2000 to September 2004, 54 patients with prostate cancer with TNM stage T1b ~ T2 underwent transabdominal LRP. The first 15 patients (group A) underwent surgery by Monstouris method; the latter 39 patients (group B) were familiar with the basic techniques of LRP after technical improvements: ligation of the retrovascularization of the vascular complex along the prostate capsule sharp separation of the prostatic apex, retaining the urethra Sphincter and urethral rectus muscle; Correct judgment of the junction of the prostate and the bladder neck, the bladder neck ring to protect the ring; rampage off the posterior lip of the bladder neck between the fascia and bladder muscle outer layer to the proximal direction of the bladder neck appropriate Free bladder neck posterior lip; fine urethra and bladder neck after anastomosis, anastomosis of the anterior wall and the posterior systolic vascular complex fixation. The operation time, blood loss, perioperative complications, postoperative control of urine recovery and serum PSA were compared between the two groups. Results 54 cases of surgery were successful. The average operative time of group A and group B was 390 (270-660) min and 240 (180-360) min, respectively. The average amount of bleeding was 430 (200-1100) ml and 160 (100-400) ml respectively. The operative complications were 6 cases and 5 cases; the time of controlling urine control was 6 months and 3 months respectively. The above indicators were significant differences between the two groups (P <0. 05). Serum PSA levels increased in group A (2 cases), group B (33 cases) increased in 1 case (6 cases were not reviewed in the recent operation), and the remaining patients had PSA <0 1 ng / ml. Conclusion With the proficiency of surgical technique and the application of urine control technique, the operation time of LRP can be shortened to 3h. Recovery control