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| 经膀胱单孔多通道腹腔镜下前列腺剜除术的初步疗效分析 |
| 王林辉△,刘冰△,吴震杰,杨庆,肖亮,王富博,罗文彬,罗睿,孙颖浩* |
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(第二军医大学长海医院泌尿外科,上海 200433
△共同第一作者
*通信作者) |
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| 摘要: |
| 目的 采用经膀胱单孔腹腔镜下前列腺剜除术治疗前列腺增生,总结初步治疗经验和体会。方法 11例前列腺增生患者,年龄67~80岁,平均(72.3±4.61)岁,体质指数18~29 kg/m2,平均(22±3.81) kg/m2；超声测量前列腺体积19.9~116.9 ml,平均(74.3±27.9) ml；IPSS评分20~35分,平均(27.1±4.89)分；残余尿量18~1 000 ml,平均(308.3±283.6) ml；6例术前最大尿流率3.5~15.7 ml/s,平均(8.42±4.09) ml/s,4例因急性尿潴留留置导尿及1例因梗阻性肾衰未行尿流率检测；术前PSA水平2.31~12.15 ng/ml,平均(6.41±2.89) ng/ml,PSA>4 ng/ml的6例患者术前穿刺结果 均为良性前列腺增生。麻醉成功后,于脐下做2 cm皮肤切口,切开白线,上推腹膜,显露膀胱顶部,在膀胱镜监视下,放置单孔多通道套件,撤出膀胱镜,连接气腹机建立气膀胱空间。置入5 mm一体式腹腔镜,以可弯剪刀沿外科包膜内缘游离并剜除增生前列腺组织,经单孔套件取出。缝合膀胱裂孔后,留置导尿,并留置耻骨后引流管自切口引出。结果 1例因放置单孔套件失败,中转开放行耻骨上前列腺剜除术。其余10例手术顺利完成,耗时120~210 min,平均(155±30.1) min,术中出血50~900 ml,平均(355±288.1) ml,仅1例术中输血1 200 ml,无其他严重并发症。10例单孔腹腔镜下切除组织12~76 ml,平均(36.8±20.2) ml,术后病理均为良性前列腺增生。术后膀胱冲洗2~4 d,平均(2.7±0.95) d,术后1~4 d拔除耻骨后引流管,平均(2.4±0.92) d,术后住院5~11 d,平均(7.1±1.73) d,2周拔除导尿管。术后随访1~3个月,最大尿流率为16.4~26.9 ml/s,平均(23.2±5.59) ml/s,残余尿量10~67 ml ,平均(38.3±13.7) ml,IPSS评分为1~4分,平均(2.1±0.86)分,排尿均正常,无尿失禁、尿潴留、排尿困难等其他并发症。结论 单中心的初步经验表明,经膀胱单孔腹腔镜前列腺剜除术安全、有效、可行,且创伤小,但确切疗效需大样本随机对照研究和长期随访观察。 |
| 关键词: 单孔腹腔镜手术 经膀胱途径 前列腺剜除术 前列腺增生 |
| DOI：10.3724/SP.J.1008.2011.01076 |
| 投稿时间：2011-07-14修订日期：2011-09-25 |
| 基金项目:上海市市级医院新兴前沿技术联合攻关项目(SHDC12010115),军队临床高新技术重大项目(2010gxjs057),上海市重点学科项目. |
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| Single-port transvesical enucleation of the prostate:an initial clinical experience with 11 cases |
| WANG Lin-hui△,LIU Bing△,WU Zhen-jie,YANG Qing,XIAO Liang,WANG Fu-bo,LUO Wen-bin,LUO Rui,SUN Ying-hao* |
(Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
△Co-first authors.
*Corresponding author.) |
| Abstract: |
| Objective To treat benign prostate hyperplasia (BPH) by single-port transvesical enucleation of the prostate (STEP) and to report our preliminary experience. Methods We performed STEP in 11 BPH patients, who had a mean age of 72.3±4.61 (ranging 67-80) years and a mean body mass index (BMI) of 22±3.81 (ranging 18-29) kg/m2. They had a mean prostate volume of 74.3±27.9 (ranging 19.9-116.9) ml (by ultrasonography), a mean IPSS of 27.1±4.89 (20-35), and a mean postvoid residual of 308.3±283.6 (18 to 1 000) ml. The mean maximum urinary flow rate was 8.42±4.09 ml/s (ranging 3.5-15.7) in 6 patients (not measured in others due to acute urinary retention in 4 patients and chronic obstructive renal failure in 1 patient). The mean baseline prostate-specific antigen (PSA) level was 6.41±2.89 (ranging 2.31-12.15) ng/ml before operation; prostate biopsy showed that 6 patients with PSA level ≥4 ng/ml had BPH. Under general anaesthesia, a 2 cm skin incision was made just below the umbilicus, the white line was incised and the peritoneum was pushed up to expose the dome of the bladder. The novel single-port device was inserted percutaneously into the bladder with assistance of cystoscopy. After establishment of pneumovesicum, the prostate adenoma was enucleated along the inner margin of its surgical capsule with a flexible scissor and extracted via the port. After suturing the bladder fissure, a three-way Foley catheter and retropubic tube were left for drainage. Results Open conversion was necessary in one case due to failure of single-port device insertion. The STEP was completed in 10 cases, with the mean operative duration being 155±30.1 (ranging 120-210) min and the estimated intraoperative blood loss being 355±288.1 (ranging 50-900) ml. One case was transfused with an amount of 1 200 ml, without any other severe complications. The mean specimen volume was 36.8±20.2 (ranging 12-76) ml, and the specimens were identified as BPH by pathological examination. Continuous bladder irrigation was used in all cases, with a mean period of 2.7±0.95 (ranging 2-4 days). The patients had a mean retropubic drainage for 2.4±0.92 (ranging 1-4) days, a mean hospital stay of 7.1±1.73 (ranging 5-11) days, and a mean duration of catheterization of 2 weeks. All 10 patients (excluding the one converted to open prostatectomy) were voiding spontaneously after the catheter retraction. The patients were followed up for 1-3 months after surgery, and it was found that the mean maximum urinary flow rate was 23.2±5.59 (ranging 16.4-26.9) ml/s, with a postvoid residual of 38.3±13.7(ranging 10-67) ml and an International Prostate Symptom Score(IPSS) of 2.1±0.86 (ranging 1-4). No patient had developed urinary incontinence, retention or dysuria. Conclusion Our initial experience shows that STEP is a safe, effective and feasible procedure, with advantages of less trauma and more cosmetic benefit, but its clinical effect needs to be observed by prospective comparative studies with a longer follow-up. |
| Key words: laparoendoscopic single-site surgery transvesical access enucleation of prostate prostatic hyperplasia |
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