【摘要】：目的:總結(jié)腹腔鏡前列腺癌根治術(shù)(LRP)治療在經(jīng)尿道前列腺電切術(shù)(TURP)中發(fā)現(xiàn)的前列腺癌的臨床經(jīng)驗。方法:回顧我院自2011年至2016年應(yīng)用LRP治療在TURP手術(shù)發(fā)現(xiàn)的前列腺癌共計14例,對其臨床資料及隨訪結(jié)果進行分析。結(jié)果:14例TURP后LRP均順利完成。TURP與LRP時間間隔1~4個月。手術(shù)時間80~220(163±94)min。失血量100~500(188±152)ml。所有病例術(shù)中無直腸損傷;無中轉(zhuǎn)開放手術(shù);無輸血;1例切緣陽性,腫瘤侵及脈管及神經(jīng)。術(shù)后留置尿管時間7~16(11.7±3.7)d。淋巴瘺1例。術(shù)后隨訪中位時間28個月(4~68個月)。13例術(shù)后12個月時尿控滿意,無尿失禁;1例隨訪不足12個月者未發(fā)生尿失禁。1例切緣陽性者給予術(shù)后放療及內(nèi)分泌治療,目前腫瘤控制良好。其余13例隨訪中未發(fā)現(xiàn)生化復(fù)發(fā)及臨床復(fù)發(fā)。結(jié)論:既往TURP手術(shù)會導(dǎo)致前列腺周圍組織水腫、粘連、纖維化及膀胱頸部瘢痕愈合,增加后續(xù)的LRP手術(shù)的難度,但是在TURP術(shù)后實施LRP仍可獲得了滿意的功能及腫瘤學(xué)預(yù)后。術(shù)者應(yīng)對上述困難應(yīng)充分了解并重視,同時患者也應(yīng)明確了解上述的手術(shù)的風(fēng)險。并由經(jīng)驗豐富的醫(yī)生來實施手術(shù)。TURP后1個月LRP似乎可以獲得更好的解剖層面,降低手術(shù)難度。
[Abstract]:Objective: to summarize the clinical experience of laparoscopic radical prostatectomy (LRP) for prostate cancer in transurethral resection of prostate (TURP). Methods: 14 cases of prostate cancer were treated with LRP in TURP from 2011 to 2016. The clinical data and follow-up results were analyzed. Results: LRP was successfully completed in 14 cases after TURP, and the interval between TURP and LRP was 1 ~ 4 months. The operative time was 80 ~ 220 (163 鹵94) min.. Loss of blood 100,500 (188 鹵152) ml. No rectal injury, no open surgery, no blood transfusion, and one case with positive incisal margin and tumor invasion of the vessels and nerves were found in all cases. The time of indwelling urethral catheter after operation was 7 ~ 16 (11.7 鹵3.7) days. Lymphatic fistula in 1 case. The median follow-up time was 28 months (4 ~ 68 months). 13 cases had satisfactory urinary control and no urinary incontinence at 12 months after operation. One case was followed up for less than 12 months without urinary incontinence. 1 case with positive margin was treated with postoperative radiotherapy and endocrine therapy. No biochemical recurrence or clinical recurrence was found in the remaining 13 cases. Conclusion: previous TURP operations may lead to edema, adhesion, fibrosis and scar healing of bladder neck, and increase the difficulty of subsequent LRP surgery. However, the implementation of LRP after TURP can still obtain satisfactory function and oncology prognosis. The surgeon should fully understand and pay attention to the above-mentioned difficulties, and the patient should also clearly understand the risks of the operation. A month after TURP, LRP seems to be able to get a better anatomical level and reduce the difficulty of surgery.
【作者單位】： 大連市中心醫(yī)院泌尿外科;
【分類號】：R737.25

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