腹腔镜前列腺癌根治术治疗经尿道前列腺电切术发现的前列腺癌14例临床分析

发布时间：2019-01-26 14:13

【摘要】：目的:总结腹腔镜前列腺癌根治术(LRP)治疗在经尿道前列腺电切术(TURP)中发现的前列腺癌的临床经验。方法:回顾我院自2011年至2016年应用LRP治疗在TURP手术发现的前列腺癌共计14例,对其临床资料及随访结果进行分析。结果:14例TURP后LRP均顺利完成。TURP与LRP时间间隔1~4个月。手术时间80~220(163±94)min。失血量100~500(188±152)ml。所有病例术中无直肠损伤;无中转开放手术;无输血;1例切缘阳性,肿瘤侵及脉管及神经。术后留置尿管时间7~16(11.7±3.7)d。淋巴瘘1例。术后随访中位时间28个月(4~68个月)。13例术后12个月时尿控满意,无尿失禁;1例随访不足12个月者未发生尿失禁。1例切缘阳性者给予术后放疗及内分泌治疗,目前肿瘤控制良好。其余13例随访中未发现生化复发及临床复发。结论:既往TURP手术会导致前列腺周围组织水肿、粘连、纤维化及膀胱颈部瘢痕愈合,增加后续的LRP手术的难度,但是在TURP术后实施LRP仍可获得了满意的功能及肿瘤学预后。术者应对上述困难应充分了解并重视,同时患者也应明确了解上述的手术的风险。并由经验丰富的医生来实施手术。TURP后1个月LRP似乎可以获得更好的解剖层面,降低手术难度。
[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 卤94) min.. Loss of blood 100,500 (188 卤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 卤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.
【作者单位】：大连市中心医院泌尿外科;
【分类号】：R737.25

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