| 摘要: |
| 目的 回顾腹腔镜前列腺癌根治术(LRP)开展初期阶段术中并发症的发生情况,分析原因并总结经验。方法 通过视频回顾的方法统计2010年1月至2012年11月3名泌尿外科医生在独立开展前20例LRP时出现的术中并发症,并收集患者一般资料、肿瘤分期等相关因素,分析发生术中并发症的原因。结果 60例LRP中共出现并发症23例(38.3%),其中导尿管被误缝7例,术中出血而中转开放5例,前列腺组织残留5例,二次吻合4例,直肠损伤1例,标本遗失1例。所有并发症均在术中得到处理。发生并发症的原因包括解剖层次不清、解剖标记不明、助手配合不默契、手术细节考虑不周全等,其中部分病例肿瘤分期偏晚、手术难度较大。结论 LRP在开展初期应尽量选择难度较低的病例,形成相对固定的手术团队,通过观摩手术,对器械选择、手术步骤、解剖标记、操作手法形成相对完善的套路,并在实践中逐步摸索和改进。 |
| 关键词: 腹腔镜前列腺癌根治术 手术中并发症 预防 |
| DOI： |
| 投稿时间：2013-03-23修订日期：2013-05-21 |
| 基金项目: |
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| Intraoperative complications of laparoscopic radical prostatectomy during initial stage application |
| YANG Bo,WANG Hui-qing,GUO Fei,SONG Rui-xiang,XU Chuan-liang,GAO Xu,HOU Jian-guo,WANG Lin-hui,SUN Ying-hao* |
(Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
*Corresponding author.) |
| Abstract: |
| Objective To retrospectively analyze the intraoperative complications of laparoscopic radical prostatectomy (LRP) during the initial application, so as to analyze the reasons and summarize the experience. Methods The videos of the 60 patients undergoing LRP for prostate cancer in our hospital between January 2010 and November 2012 were reviewed to analyze the intraoperative complications. The patients were the first 20 cases done by 3 surgeons independently. The clinical data, tumor staging, and other related factors were collected for analyzing the reasons for complications of LRP. Results Complications were observed intraoperatively in the 23 patients. The most frequent complications included mistaken suture of bladder catheter (7 cases), open conversion due to intraoperative bleeding (5 cases), residual prostate tissue (5 cases), secondary anastomosis (4 cases), rectal injury (1 case), and specimen missing (1 case). All the events were managed during the operation. The reasons for the complications included unclear anatomical structure, unclear surgical landmark, poor cooperation with assistants, and inconsiderate operative details. Some patients were in the advanced stage, making it difficult to perform the operation. Conclusion The patients with low surgical risk should be chosen for the initial application of LRP, and a stable operation team should be formed. A standard strategy should be formed regarding the equipment selection, surgical procedure, anatomic marking, and manipulation based on viewing the operation; and improvement should be made gradually in practice. |
| Key words: laparoscopic radical prostatectomy intraoperative complications prevention |
