Eden C G, Cahill D, Vass J A, Adams T H, Dauleh M I
Departments of Urology, The North Hampshire Hospital and Frimley Park Hospital, UK.
BJU Int. 2002 Dec;90(9):876-82. doi: 10.1046/j.1464-410x.2002.03049.x.
To test the reproducibility of other series of laparoscopic radical prostatectomy (LRP) for safety, efficacy and early oncological and functional results.
One hundred consenting patients with clinically localized adenocarcinoma of the prostate and a Gleason sum of < or = 8 opting for surgery underwent LRP undertaken by one surgeon. Their mean (range) age was 62.2 (52-72) years, weight 78.8 (65-100) kg, prostate specific antigen (PSA) level 8.0 (2-32) ng/mL, and Gleason sum 6.0 (4-8). A five-port antegrade transperitoneal technique was used in all cases.
The mean (range) operative duration was 245 (145-600) min, blood loss 313 (50-1300) mL, parenteral morphine sulphate administration 20.2 (0-160) mg and hospital stay after LRP 4.2 (3-13) nights. Bilateral neurovascular bundle preservation was attempted in 58% of patients. The transfusion rate was 3%. The conversion and re-intervention rates were 1% and 2%, respectively. There were eight complications, six of which were in the initial 26 cases, i.e. bladder neck stenosis (two), and rectal injury, laparotomy for bleeding, premature drain removal leading to urinary peritonitis, ulnar nerve neuropraxia, port-site hernia and paralytic ileus in one each. The positive surgical margin rate was 16%. All patients had a PSA level of < or = 0.1 ng/mL at 3 months. By 1 year 90% of patients were pad-free and 62% operated on using a bilateral nerve-sparing technique had erections. There were no biochemical failures. The mean (range) follow-up was 9.8 (1-24) months.
The present results are similar to those reported by other centres with greater experience and confirm that LRP is an effective, safe and precise technique. Once intial experience has been gained it offers advantages over open surgery in the form of a dry and magnified operative site, and a lower likelihood of blood transfusion, in addition to the generic advantages of laparoscopy.
测试其他系列腹腔镜根治性前列腺切除术（LRP）在安全性、有效性以及早期肿瘤学和功能结果方面的可重复性。
100例自愿选择手术治疗的临床局限性前列腺腺癌患者，其Gleason评分≤8分，由一名外科医生实施LRP。他们的平均（范围）年龄为62.2（52 - 72）岁，体重78.8（65 - 100）kg，前列腺特异性抗原（PSA）水平8.0（2 - 32）ng/mL，Gleason评分为6.0（4 - 8）。所有病例均采用五孔顺行经腹技术。
平均（范围）手术时间为245（145 - 600）分钟，失血量313（50 - 1300）mL，静脉注射硫酸吗啡20.2（0 - 160）mg，LRP术后住院时间4.2（3 - 13）晚。58%的患者尝试保留双侧神经血管束。输血率为3%。中转率和再次干预率分别为1%和2%。共出现8例并发症，其中6例出现在最初的26例患者中，即膀胱颈狭窄（2例）、直肠损伤、因出血行剖腹手术、过早拔除引流管导致尿性腹膜炎、尺神经神经失用症、切口疝和麻痹性肠梗阻各1例。手术切缘阳性率为16%。所有患者在3个月时PSA水平≤0.1 ng/mL。到1年时，90%的患者无需使用尿垫，采用双侧神经保留技术手术的患者中有62%能够勃起。无生化复发。平均（范围）随访时间为9.8（1 - 24）个月。
目前的结果与其他经验更丰富的中心报告的结果相似，证实LRP是一种有效、安全且精确的技术。一旦获得初步经验，除了腹腔镜手术的一般优势外，它在手术视野干燥且放大、输血可能性较低方面比开放手术更具优势。
