Vallancien Guy, Guillonneau Bertrand, Cathelineau Xavier, Baumert Hervé, Doublet Jean-Dominique
Institut Mutualiste Montsouris, Département d'urologie, 46 bld Jourdan-75674 Paris.
Bull Acad Natl Med. 2002;186(1):117-23; discussion 123-4.
The authors present their experience in the technique of laparoscopic radical prostatectomy. After 841 operations done from January 1998 to april 2001. They use a trans peritoneal approach with 5 ports of 5 and 10 mm. The prostatectomy is done antegrady and the urethrovesical anastomosis is rebuilt with interrupted 3/0 resorbable sutures. Operating time is 2 hours and 40 minutes (1 h 30 to 6 h 30) Conversion rate is 0.9%, average bleeding is 330 cc and transfusion rate is 2.8%. Bladder catheter is removed between days 3 to 6. hospital stay is 5.8 days. Post-op pain is minimal (2% of antalgics at day 2). There was no death, no embolism, 0.2% of phlebitis, 1.1% of rectal injury. Anstomotic strictures occur in 0.3% of cases. 89.2% of patients are continent after 1 year and 75% of patients under 70 years old who underwent a bilateral nerve sparing procedure were potent at 6 months. Positive margins were observed in 5% of pT2a, 22.5% of pT2b, 22.7% in pT3a and 30% in PT3b. After 2 years 92.5% of patients pT2a and b have a PSA < 0.1 ng/ml. No port seeding or peritoneal invasion by cancer was observed. Laparoscopic radical prostatectomy is a safe surgical procedure which limits the risk of transfusion, of anastomotic stricture, which reduces post op pain and allows a good continence. Potency recovery is promising.
作者介绍了他们在腹腔镜根治性前列腺切除术技术方面的经验。在1998年1月至2001年4月完成841例手术后，他们采用经腹途径，使用5个5毫米和10毫米的端口。前列腺切除术整块进行，尿道膀胱吻合口用3-0可吸收间断缝线重建。手术时间为2小时40分钟（1小时30分钟至6小时30分钟），中转率为0.9%，平均失血量为330毫升，输血率为2.8%。导尿管在术后第3至6天拔除，住院时间为5.8天。术后疼痛轻微（术后第2天2%使用镇痛药）。无死亡、无栓塞，静脉炎发生率为0.2%，直肠损伤发生率为1.1%。吻合口狭窄发生率为0.3%。89.2%的患者术后1年控尿良好，75%接受双侧神经保留手术的70岁以下患者在术后6个月仍有性功能。pT2a期患者切缘阳性率为5%，pT2b期为22.5%，pT3a期为22.7%，pT3b期为30%。2年后，92.5%的pT2a和b期患者前列腺特异性抗原（PSA）<0.1纳克/毫升。未观察到端口种植或癌性腹膜侵犯。腹腔镜根治性前列腺切除术是一种安全的手术方法，可降低输血风险、吻合口狭窄风险，减轻术后疼痛，并能实现良好的控尿。性功能恢复前景良好。
