腹腔镜前列腺癌根治术的应用解剖学研究

发布时间：2018-03-31 02:19

本文选题：腹腔镜　切入点：前列腺癌　出处：《第一军医大学》2006年博士论文

【摘要】：腹腔镜前列腺癌根治术(laparoscopic radical prostatectomy，LRP)目前在欧洲和美国已成为临床上治疗局限性前列腺癌的常规手术，有取代开放性前列腺癌根治术的趋势，在中国还处于初始阶段。该技术是兼顾微创性和开放性手术优点的新技术，对病人而言，具有微创、早期拔除尿管、失血量少近乎不输血、住院时间短、术后恢复快、术中术后并发症明显减少的优点；对手术医生而言，具有手术视野的高清晰度、尿道膀胱吻合的精确性和严密性好的优点。该手术不会因微创性而影响术后的肿瘤学结果，，功能学结果与开放手术相似。但该手术要求高和需要相当长的学习曲线，刚开展该手术时存在手术时间较长，增加发生并发症的危险性的缺点，现在术后功能学结果如排尿功能和性功能仍不满意。对前列腺神经血管束和海绵体神经、尿道横纹括约肌的神经支配的神经解剖学方面目前仍有许多不清楚的地方，如何减少手术阳性切缘，尤其是医源性人为手术阳性切缘，尚需改进手术技巧和方法来解决，还缺乏该手术的镜下解剖学研究。这些就成为临床解剖学者和外科医生所面临的迫切任务。本研究利用固定尸体及新鲜尸体、活体腹腔镜观察来阐明前列腺神经血管束和正常前列腺及周围结构的解剖组织学特点、尿道横纹括约肌的控尿神经支配及微创前列腺癌根治术的镜下解剖学特点。
[Abstract]:Laparoscopic radical prostatectomy (LRP) has become a routine procedure for the treatment of localized prostate cancer in Europe and the United States. It has a tendency to replace open radical prostatectomy, and is still in its infancy in China.This technique is a new technique which takes into account the advantages of minimally invasive and open surgery. For the patients, it has the advantages of minimally invasive, early extubation, less blood loss, less blood loss, shorter hospitalization time, faster postoperative recovery, and less complications during and after operation.For the surgeon, it has the advantages of high definition of operative visual field, accuracy and strictness of urethral and bladder anastomosis.This procedure does not affect the postoperative oncology results due to minimally invasive surgery, and the functional results are similar to open surgery.However, the operation requires a long learning curve and needs a long learning curve. It has the disadvantages of long operation time and increasing the risk of complications. Now the functional results such as urination and sexual function are still unsatisfactory.There are still many unclear aspects in the neuroanatomy of the prostatic nerve vessel bundle and cavernous nerve, the innervation of the transverse sphincter of the urethra, and how to reduce the surgical positive margin, especially the iatrogenic artificial surgical positive margin.The surgical techniques and methods need to be improved and there is a lack of endoscopic anatomical study of the operation.These become clinical anatomists and surgeons facing the urgent task.In this study, the anatomical and histological characteristics of the neurovascular bundle of the prostate and the normal prostate and its surrounding structures were elucidated by using fixed and fresh cadavers and in vivo laparoscopic observation.The innervation of urethral sphincter and the anatomical features of minimally invasive radical prostatectomy for prostate cancer.
【学位授予单位】：第一军医大学
【学位级别】：博士
【学位授予年份】：2006
【分类号】：R737.25;R322

【引证文献】