经腹与经腹膜外腹腔镜下前列腺癌根治术的效果比较

目的 比较经腹与经腹膜外途径腹腔镜下手术治疗前列腺癌的临床效果.方法前列腺癌患者33例行腹腔镜下前列腺癌根治术,其中经腹21例,经腹膜外12例.对2组患者手术时间、术中出血量、术中并发症、肠功能恢复时间、术后住院时间、术后并发症等资料进行比较分析.结果 33例手术均成功.经腹与经腹膜外2组手术时间分别为(299±46)和(309±64)min,出血量分别为(618±448)和(677±469)ml,2组比较差异无统计学意义(P＞0.05).经腹组术中发生大出血3例、膀胱损伤2例、单侧输尿管损伤1例,经腹膜外组术中发生大出血1例、闭孔神经损伤1例、腹膜损伤1例、膀胱三角损伤1例.2组术后留置导尿时间分别为(14.6±3.8)和(12.3±2.9)d,肠功能恢复时间分别为(2.7±0.7)和(2.1±0.5)d,术后住院时间分别为(17.0±3.6)d和(11.2±3.5)d,2组比较差异均有统计学意义(P＜0.05).结论 腹腔镜下前列腺癌根治术经腹膜外比经腹途径具有视野清晰、对腹腔器官影响小、术后恢复快、术后住院短等优点.

Comparison of transperitoneal and extraperitoneal laparoscopic radical prostatectomy

Objective To compare the clinical features and results between transperitoneal laparoscopic radical prostatectomy and extraperitoneal laparoscopic radical prostatectomy.Methods Thirty-three prostate cancer patients treated with laparoscopic radical prostatectomy. Among them,21 cases had been done transperitoneally and 12 cases had been done extroperitoneally. The two different approaches were evaluated and compared in respects of operating time, estimated blood loss, complications during surgery, postoperative complications, intestinal function recovery time, catheterization time and length of hospital stay.Results All the surgeries had completed successfully without conversion to open surgery. For transperitoneal approach and extraperitoneal approach, the operating time was (299±46)min and (309±64)min, blood loss was (618±448)ml and (677±469)ml. There were 3 cases with severe blood loss, 2 cases with bladder injuries and 1 case with ureteral injury in transperitoneal approach group. There were 1 case with severe blood loss, 1 case with obturator never injury, 1 case with cysto-ureteral injury and 1 case with peritoneum injury in extraperitoneal approach group. For transperitoneal approach and extraperitoneal approach,the catheterization time was(14.6±3.8)d and (12.3±2.9)d, intestinal function recovery time was (2.7±0.7)d and (2.1±0.5)d, length of hospital stay was (17.0±3.6)d and (11.2±3.5)d, respectively.Conclusions Laparoscopic radical prostatectomy is feasible and safe in clinical practice. Extraperitoneal approach has better vision, less impact on abdominal organs, faster recovery and shorter hospital stay comparing to transperitoneal approach.