Gregori Andrea, Simonato Alchiede, Lissiani Andrea, Bozzola Andrea, Galli Stefano, Gaboardi Franco
Division of Urology, Department of Surgery, Luigi Sacco Hospital, Milan, Italy.
Eur Urol. 2003 Aug;44(2):190-4; discussion 194. doi: 10.1016/s0302-2838(03)00261-6.
We retrospectively evaluated the intraoperative and early postoperative complications of the initial experience with the first 80 laparoscopic radical prostatectomies performed at our institution.
Between January 17, 2001 and July 24, 2002, 80 patients between 53 and 78 years old (mean age 63.8) with clinically localized prostate cancer underwent laparoscopic radical prostatectomy with the Montsouris technique. A total of 24 (30%) staging pelvic lymphadenectomy were performed. The inpatient and outpatient medical records as well as all complications were reviewed.
The pathological tumor stage revealed 18 pT2a (22.5%), 29 pT2b (36.25%), 21 pT3a (26.25%), 10 pT3b (12.5%), 1 pT4 (1.25%), 1 pT4 N1 (1.25%). No conversion was necessary in all cases. Mean operative time was 218 minutes (range 150-420) overall, mean blood loss was 376 ml (range 50-1000) and the mean postoperative hospital stay was 4.5 days (range 3-9). The mean and the median duration of bladder catheterization were respectively 11 and 10 days (range 7-23). Injury to the epigastric vessels was detected intraoperatively in 5 cases (6.25%) with immediate hemostasis achieved. There was 1 death (1.25%) 35 days after a cerebrovascular accident occurred on postoperative day 3. We observed 1 (1.25%) postoperative ileus, hemoperitoneum in 5 cases (6.25%), 2 (2.5%) acute urinary retentions, 6 (7.5%) anastomotic leakages, 1 (1.25%) anastomotic stricture, 1 (1.25%) hydrocele and 2 (2.5%) urinary tract infections.
In our initial experience laparoscopic radical prostatectomy was performed with no complications in 77.5% of patients. We observed major and minor complications respectively in 16.25% and 6.25% of the patients. Our series provides evidence that the laparoscopic approach is feasible and associated with acceptable perioperative morbidity.
我们回顾性评估了在本机构进行的首例80例腹腔镜根治性前列腺切除术的术中及术后早期并发症。
2001年1月17日至2002年7月24日，80例年龄在53至78岁（平均年龄63.8岁）的临床局限性前列腺癌患者接受了采用蒙特苏里技术的腹腔镜根治性前列腺切除术。共进行了24例（30%）分期盆腔淋巴结清扫术。对住院和门诊病历以及所有并发症进行了回顾。
病理肿瘤分期显示18例pT2a（22.5%），29例pT2b（36.25%），21例pT3a（26.25%），10例pT3b（12.5%），1例pT4（1.25%），1例pT4 N1（1.25%）。所有病例均无需中转。总体平均手术时间为218分钟（范围150 - 420分钟），平均失血量为376毫升（范围50 - 1000毫升），术后平均住院时间为4.5天（范围3 - 9天）。膀胱导尿的平均和中位持续时间分别为11天和10天（范围7 - 23天）。术中发现5例（6.25%）患者出现腹壁血管损伤，均立即实现止血。术后第3天发生脑血管意外，35天后有1例死亡（1.25%）。我们观察到1例（1.25%）术后肠梗阻，5例（6.25%）腹腔积血，2例（2.5%）急性尿潴留，6例（7.5%）吻合口漏，1例（1.25%）吻合口狭窄，1例（1.25%）鞘膜积液和2例（2.5%）尿路感染。
在我们的初步经验中，77.5%的患者进行腹腔镜根治性前列腺切除术时无并发症。我们分别在16.25%和6.25%的患者中观察到了严重和轻微并发症。我们的系列研究提供了证据，表明腹腔镜手术方法是可行的，且围手术期发病率可接受。
