经腹膜外途径腹腔镜前列腺癌根治术（28例报告）

发布时间：2018-04-04 17:28

本文选题：经腹膜外　切入点：腹腔镜　出处：《重庆医科大学》2014年硕士论文

【摘要】：目的探讨经腹膜外途径腹腔镜前列腺癌根治术（ELRP）治疗局限性前列腺癌的临床价值，总结术后并发症的原因及处理经验。方法回顾分析2011年8月至2013年6月我科28例局限性前列腺癌患者行ELRP的临床资料。年龄:54岁～76岁，平均年龄68.6岁。术前病理报告均为前列腺癌，术前临床分期T1期11例，T2期17例。Gleason评分3~9分。前列腺特异性抗原（PSA）1.02ng/ml~88.76ng/ml。结果28例手术均顺利完成，手术时间125～210min，平均160min。术中出血量100～850ml，平均245ml，，1例予以术中输血。术后住院时间7～26d，平均11.2d。术后留置尿管时间15～28d，平均20.5d。3例患者发生尿漏，经保守治疗后均痊愈。8例患者出现尿失禁，7例经过膀胱训练及盆底肌锻炼等康复治疗后尿控能力均得到恢复，1例出现真性尿失禁。无周围脏器损伤。2例出现尿道狭窄,分别经尿道扩张和膀胱颈口狭窄切开术后排尿均恢复通畅。术后病理切缘阳性1例。术后随访5月～23月，平均10.8月，未发现肿瘤复发或转移，术后3月PSA＜0.14ng/ml。结论ELRP是一种治疗局限性前列腺癌切实可行的微创手术方法，熟练掌握手术操作技巧是达到手术安全、有效的关键。
[Abstract]:Objective to evaluate the clinical value of laparoscopic radical prostatectomy (ELRP) in the treatment of localized prostate cancer, and to summarize the causes of postoperative complications and experience in management.Methods from August 2011 to June 2013, 28 patients with localized prostate cancer underwent ELRP.The average age is 68.6 years.The preoperative pathological findings were all prostate cancer. The preoperative clinical staging was T 1 stage and T 2 stage 17 cases. Gleason score was 3 ~ 9 points.The prostate specific antigen (PSAA) was 1.02ng / ml, 88.76ng / ml.Results all the 28 cases were successfully completed, the operation time was 125 minutes and 210 minutes, with an average of 160 minutes.The volume of blood loss during operation was 100 to 850 ml, with an average of 245 ml, and 1 case received intraoperative blood transfusion.The postoperative hospitalization time was 7 days and 26 days, with an average of 11.2 days.The mean time of indwelling urethral catheter after operation was 1528 days. Urinary leakage occurred in an average of 20.5d.3 patients. After conservative treatment, urinary incontinence was recovered in 8 cases. Urinary control ability was recovered in 7 cases after bladder training and pelvic floor muscle exercise. One case had genuine urinary incontinence.The urethral stricture was found in 2 cases without peripheral organ injury. The urethral stricture and transurethral dilatation of bladder neck were all recovered after transurethral urethral dilatation.Postoperative pathological margin was positive in 1 case.The postoperative follow-up ranged from 5 to 23 months (mean 10.8 months). No tumor recurrence or metastasis was found. The PSA was less than 0.14 ng / ml 3 months after operation.Conclusion ELRP is a feasible minimally invasive method for the treatment of localized prostate cancer. Mastering the operative skills is the key to the safety and effectiveness of the operation.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.25

【参考文献】