Rassweiler Jens, Stolzenburg Jens, Sulser Tullio, Deger Serdar, Zumbé Jürgen, Hofmockel Georg, John Hubert, Janetschek Günther, Fehr Jean-Luc, Hatzinger Martin, Probst Michael, Rothenberger Karl-Heinz, Poulakis Vassilis, Truss Michael, Popken Gralf, Westphal Jens, Alles Uwe, Fornara Paolo
Department of Urology, SLK Kliniken Heilbronn, University of Heidelberg, Am Gesundbrunnen 20, D-77074 Heilbronn, Germany.
Eur Urol. 2006 Jan;49(1):113-9. doi: 10.1016/j.eururo.2005.10.003. Epub 2005 Nov 2.
To present the current status of laparoscopic radical prostatectomy (LRP) in Germany, Austria and Switzerland with respect to transferability, learning curve, and outcome.
The data of 5824 patients who underwent LRP in 18 centers by 50 urologists from March 1999 to August 2004 were analyzed retrospectively. Three centers performed more than 500, and six more than 250 cases. A transperitoneal descending technique with was used in 2701, a transperitoneal ascending in 1234, an extraperitoneal descending in 1814, and an extraperitoneal ascending modification in 75 cases. Specimen showed pT2 in 3535, pT3a in 1555, pT3b in 623, and pT4 in 111 cases.
Mean operating time averaged 211 (131-292) minutes, with shorter duration of the extraperitoneal descending technique. Conversion to open surgery averaged 2.4 (0-14.1) %. Re-intervention rate amounted to 2.7 (0.3-7.7) %. Complication rate averaged 8.9 (1.8-10.8) % including bleeding (0.3-2.5%) and rectal lesion (1.5-2.5%). The rate of positive margins was 10.6 (3.2-18) % for pT2- and 32.7 (20-38.5) % for pT3a-tumors Continence after 12 months was 84.9 (72-94) %. Data about potency (7 centers) revealed 52.5 (35-67) % full erections following bilateral nerve preservation. 5 year-PSA recurrence rate (3 centers) was 8.6 (4-15.3) % for pT2-tumors and 17.5 (15-20.6) % for pT3a-stages.
The results confirm the efficacy of the training program with safe transfer of LRP (i.e. low complication rate), however including all known problems of a retrospective study.
介绍德国、奥地利和瑞士腹腔镜根治性前列腺切除术（LRP）在可转移性、学习曲线和手术结果方面的现状。
回顾性分析了1999年3月至2004年8月间50位泌尿外科医生在18个中心为5824例患者实施LRP的数据。3个中心手术例数超过500例，另有6个中心超过250例。采用经腹膜下行技术的有2701例，经腹膜上行技术的有1234例，腹膜外下行技术的有1814例，腹膜外上行改良技术的有75例。标本显示pT2期3535例，pT3a期1555例，pT3b期623例，pT4期111例。
平均手术时间为211（131 - 292）分钟，腹膜外下行技术的手术时间较短。转为开放手术的平均比例为2.4（0 - 14.1）%。再次干预率为2.7（0.3 - 7.7）%。并发症发生率平均为8.9（1.8 - 10.8）%，包括出血（0.3 - 2.5%）和直肠损伤（1.5 - 2.5%）。pT2期肿瘤切缘阳性率为10.6（3.2 - 18）%，pT3a期肿瘤为32.7（20 - 38.5）%。12个月后的控尿率为84.9（72 - 94）%。关于性功能（7个中心）的数据显示，双侧神经保留后完全勃起的比例为52.5（35 - 67）%。pT2期肿瘤的5年PSA复发率（3个中心）为8.6（4 - 15.3）%，pT3a期为17.5（15 - 20.6）%。
结果证实了培训计划的有效性，LRP可安全转移（即并发症发生率低），不过包含了回顾性研究的所有已知问题。
