Gillitzer Rolf, Melchior Sebastian W, Hampel Christian, Wiesner Christoph, Fichtner Jan, ThUroff Joachim W
Department of Urology, Johannes Gutenberg-University Medical School, Mainz, Germany.
J Urol. 2004 Jul;172(1):124-8. doi: 10.1097/01.ju.0000128570.39667.5e.
Although groups at several institutions have long experience with radical perineal prostatectomy (RPP), only few reports of larger series describe associated complications, mostly without reporting management options in detail. We analyzed specific perioperative and postoperative complications of the perineal approach and management strategies thereof.
The medical records of 630 patients who underwent RPP between January 1997 and May 2003 were retrospectively reviewed in regard to complications and their management. Median followup was 8 months (range 1 to 68).
Major complications requiring open surgical intervention were noted in 11 patients (1.7%) for a total surgical revision rate of 2.4% (15 of 630). Two patients with persistent urinary fistula required fistula excision and closure. Two patients with a rectocutaneous fistula needed temporary diverting colostomy. Three patients with a combined urinary and fecal fistula were treated with protective colostomy, fistula excision and the interposition of a tunica vaginalis graft. No further morbidity was observed in these patients. In 7 patients a subvesical hematoma was drained surgically, including 3 mentioned in whom a hematoma expanded into the urethral anastomosis. Minor complications, which could be successfully managed conservatively or with endoscopic interventions only, developed in 124 patients for a total rate of 19.7%. In the long term 9% of the patients experienced postoperative de novo changes in stool habits after RPP but only 2.7% reported distressing anal sphincter incompetence.
RPP is a safe and reproducible procedure with low major complication and reintervention rates even in a training center setting with many involved surgeons. A subvesical hematoma should be revised early since it can be the origin of subsequent major complications.
尽管多家机构的团队对根治性会阴前列腺切除术（RPP）有着长期经验，但仅有少数关于较大病例系列的报告描述了相关并发症，且大多未详细报告处理方法。我们分析了会阴入路的围手术期和术后特定并发症及其处理策略。
回顾性分析了1997年1月至2003年5月期间接受RPP的630例患者的病历，内容涉及并发症及其处理情况。中位随访时间为8个月（范围1至68个月）。
11例患者（1.7%）出现需要开放手术干预的主要并发症，总手术修正率为2.4%（630例中的15例）。2例持续性尿瘘患者需要进行瘘管切除和闭合术。2例直肠皮肤瘘患者需要临时改道结肠造口术。3例合并尿瘘和粪瘘的患者接受了保护性结肠造口术、瘘管切除术并置入了鞘膜移植片。这些患者未观察到进一步的发病情况。7例患者的膀胱下血肿接受了手术引流，其中3例血肿扩展至尿道吻合口。124例患者出现了仅通过保守治疗或内镜干预即可成功处理的轻微并发症，总发生率为19.7%。长期来看，9%的患者在RPP术后出现了新的排便习惯改变，但只有2.7%的患者报告有令人困扰的肛门括约肌功能不全。
即使在有许多外科医生参与的培训中心环境中，RPP也是一种安全且可重复的手术，主要并发症和再次干预率较低。膀胱下血肿应尽早处理，因为它可能是随后主要并发症的根源。
