| 摘要: |
| 目的 探讨腹腔镜前列腺癌根治术后吻合口尿漏的防治方法。 方法 自2006年1月至2011年1月,我院行腹腔镜前列腺癌根治术151例,其中采取双针连续尿道膀胱吻合法58例、传统尿道膀胱缝合法93例。出现持续性尿道膀胱吻合口尿漏8例(5.3%,8/151),平均年龄66(53~78)岁;术前总前列腺特异抗原(T-PSA)平均34.3(1.1~165.0) ng/ml;Gleason评分<7分4例、7分2例、>7分2例;TNM T1c 5例、T2a 2例、T2c 1例;平均手术时间202(60~360) min;均采用调整导尿管位置、持续低张力牵拉导尿管,并保持导尿管、耻骨后引流管通畅,预防感染、减少液体摄入量,同时加强营养等保守处理方法。保守治疗失败的病例,行腹腔镜下吻合口尿漏修补。 结果 采取双针连续尿道膀胱吻合法的病例,均未出现持续性吻合口尿漏,明显优于传统法缝合组 。6例经保守处理治愈,2例行腹腔镜下吻合口尿漏修补治愈。平均33 (21~43) d拔除导尿管,术后平均随访39(22~60)个月,无尿道狭窄发生。 结论 采取双针连续尿道膀胱吻合法可以有效防止吻合口尿漏的发生,保守治疗、腹腔镜下修补是处理术后持续性吻合口尿漏的有效方法。 |
| 关键词: 前列腺肿瘤 前列腺癌根治术 腹腔镜检查 吻合口尿漏 |
| DOI：10.3724/SP.J.1008.2011.01197 |
| 投稿时间：2011-07-02修订日期：2011-10-20 |
| 基金项目: |
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| Prevention and treatment of urethrovesical anastomotic leakage following laparoscopic radical prostatectomy |
| LI Xun-gang,CUI Xin-gang,XU Dan-feng*,CHEN Jie,CHEN Ming,LI Yao |
(Department of Urology, Urology Center of PLA, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
*Corresponding author.) |
| Abstract: |
| Objective To search for method for treatment and prevention of urethrovesical anastomotic leakage (PUAL) following laparoscopic radical prostatectomy (LRP). Methods Eight (5.3%) of the 151 laparoscopic radical prostatectomies performed between Jan. 2006 and Jan. 2011 developed PUAL. Running urethrovesical anastomosis was used for 58 patients and traditional suture was used in 93 during LRP. The mean age of the 8 patients was 66 years (ranging 53 to 78 years), the mean preoperative total prostate specific antigen(T-PSA) was 34.3 ng/ml (ranging 1.1 to 165.0 ng/ml). The preoperative Gleason sum was <7 in 4 patients, 7 in 2, and > 7 in 2 patients. The mean preoperative Gleason score was 7 (ranging 5 to 9). Pathological stage was T1c in 5, T2a in 2, and T2c in 1 patient. The mean operation time was 202 min (ranging 60 to 360 min). Several treatments were used, including prolonged retropubic drainage, bladder catheter traction, drain position adjustment, reduction of fluid intake, delayed bladder catheter removal and enhancing nutrition for patients. Patients underwent reoperation using a laparoscopic approach after failure of the initial management. Results PUAL was not observed in LRP cases with running laparoscopic suture technique, which was significantly better than cases with traditional suture method (0 vs 8.6% ,P<0.05). Six patients were cured by conservative treatments, 2 patients required reintervention via a laparoscopic approach. The catheters of all patients were removed after a mean of 33 d (ranging 21-43 d). Urethral stricture was not found during a 39-month follow-up(ranging 22 to 60 months). Conclusion Urethrovesical anastomotic leakage can be effectively avoided by running urethrovesical anastomosis; conservative treatment and laparoscopic repair are effective managements to treat PUAL. |
| Key words: prostatic neoplasms prostatectomy laparoscopy anastomotic urinary leakage |
