Rozet François, Galiano Marc, Cathelineau Xavier, Barret Eric, Cathala Nathalie, Vallancien Guy
Department of Urology, Institut Montsouris, Université Pierre et Marie Curie, Paris, France.
J Urol. 2005 Sep;174(3):908-11. doi: 10.1097/01.ju.0000169260.42845.c9.
We report our experience with the extraperitoneal approach to laparoscopic radical prostatectomy. We describe the technique, clinical and oncological results, and functional outcome.
From February 2002, to March 2004, 600 laparoscopic radical prostatectomies were performed by an extraperitoneal approach and evaluated prospectively.
A total of 599 extraperitoneal procedures were performed successfully. Mean operative time was 173 minutes. Mean operative blood loss was 380 cc. The transfusion rate was 1.2%. The major and minor complications rate was 2.3% and 9.2%, respectively. The reoperation rate was 1.7%. Mean hospital stay was 6.3 days. Pathological stage was pT2 and pT3 in 72% and 28% of cases, respectively. Mean Gleason score was 7. The overall positive margin rate was 17.7% (14.6% and 25.6% of pT2 and pT3 tumors, respectively). Median followup was 12 months. Of the patients 95% had prostate specific antigen less than 0.2 ng/ml. Patients were evaluated by a self-questionnaire sent by mail before and after surgery (International Continence Society and International Index of Erectile Function-5). At a median followup of 12 months 84% of the patients were continent (no pad), 7% used 1 precautionary pad and 7% needed 1 pad routinely. At a median followup of 6 months in preoperatively potent patients (International Index of Erectile Function-5 greater than 20) the postoperative erection and intercourse rate was 64% and 43%, respectively, in those with bilateral nerve bundle preservation.
The extraperitoneal technique is a reliable approach to laparoscopic radical prostatectomy.
我们报告经腹膜外途径行腹腔镜前列腺癌根治术的经验。我们描述该技术、临床及肿瘤学结果和功能转归。
从2002年2月至2004年3月，采用经腹膜外途径进行了600例腹腔镜前列腺癌根治术，并进行前瞻性评估。
共成功实施了599例经腹膜外手术。平均手术时间为173分钟。平均术中失血380毫升。输血率为1.2%。主要和次要并发症发生率分别为2.3%和9.2%。再次手术率为1.7%。平均住院时间为6.3天。病理分期pT2和pT3分别占病例的72%和28%。平均Gleason评分7分。总体切缘阳性率为17.7%（pT2和pT3肿瘤分别为14.6%和25.6%）。中位随访时间为12个月。95%的患者前列腺特异性抗原小于0.2纳克/毫升。通过术前和术后邮寄的自我调查问卷对患者进行评估（国际尿失禁学会和国际勃起功能指数-5）。在中位随访12个月时，84%的患者控尿（无需尿垫），7%使用1片预防性尿垫，7%需要常规使用1片尿垫。在术前有勃起功能的患者（国际勃起功能指数-5大于20）中位随访6个月时，双侧神经束保留患者的术后勃起和性交率分别为64%和43%。
经腹膜外技术是腹腔镜前列腺癌根治术的一种可靠方法。
