Baumert H, Ballaro A, Dugardin F, Kaisary A V
Fondation Hôpital Saint Joseph, Paris, France.
J Urol. 2006 May;175(5):1691-4. doi: 10.1016/S0022-5347(05)00986-9.
Laparoscopic simple prostatectomy has recently been developed to remove large prostatic adenomas causing bladder outflow obstruction. To our knowledge the advantages of the laparoscopic vs the standard open approach to this procedure remain undefined. We compared laparoscopic and open simple prostatectomy.
Perioperative data on the first 30 consecutive laparoscopic simple prostatectomies performed by 1 surgeon were collected prospectively and compared with retrospectively collected data on a series of 30 consecutive open simple prostatectomies. A Millin and a transvesical-prostatic technique were used in the laparoscopic group and a transvesical technique was used in the open group.
There was no significant difference in prostatic size, patient age or body mass index between the 2 groups. In the laparoscopic group the mean International Prostate Symptom score +/- SD improved from 22.4 +/- 6.9 to 5.7 +/- 3.6 and the urinary flow rate improved from 8.1 +/- 2.5 to 24.6 +/- 12.1 ml per minute (each p <0.001). Mean total blood loss (367 +/- 363 vs 643 +/- 647 ml), irrigation time (0.33 +/- 0.7 vs 4 +/- 3.5 days), duration of catheterization (4 +/- 1.7 vs 6.8 +/- 4.7 days) and hospital stay (5.1 +/- 1.8 vs 8 +/- 4.8 days) were significantly less in the laparoscopic group than in the open group. Mean operative time was longer in the laparoscopic group (115 +/- 30 vs 54 +/- 19 minutes). Of the 30 patients in the laparoscopic group 24 did not require bladder irrigation. There was no apparent difference in the incidence or severity of complications. There was no difference in perioperative parameters or functional results between the 2 different laparoscopic techniques.
Laparoscopic simple prostatectomy has inherent advantages over the open technique. Further studies are indicated to determine whether this technique should be considered the treatment of choice for prostatic adenomas too large for safe endoscopic resection.
腹腔镜单纯前列腺切除术最近已被开发用于切除导致膀胱流出道梗阻的大型前列腺腺瘤。据我们所知，腹腔镜手术与标准开放手术相比，该手术的优势尚不明确。我们比较了腹腔镜单纯前列腺切除术和开放单纯前列腺切除术。
前瞻性收集了由1名外科医生连续进行的前30例腹腔镜单纯前列腺切除术的围手术期数据，并与回顾性收集的一系列连续30例开放单纯前列腺切除术的数据进行比较。腹腔镜组采用Millin术式和经膀胱前列腺技术，开放组采用经膀胱技术。
两组患者的前列腺大小、年龄或体重指数无显著差异。腹腔镜组的平均国际前列腺症状评分±标准差从22.4±6.9改善至5.7±3.6，尿流率从8.1±2.5提高至24.6±12.1毫升/分钟（均p<0.001）。腹腔镜组的平均总失血量（367±363 vs 643±647毫升）、冲洗时间（0.33±0.7 vs 4±3.5天）、导尿持续时间（4±1.7 vs 6.8±4.7天）和住院时间（5.1±1.8 vs 8±4.8天）均显著少于开放组。腹腔镜组的平均手术时间较长（115±30 vs 54±19分钟）。腹腔镜组的30例患者中有24例不需要膀胱冲洗。并发症的发生率或严重程度无明显差异。两种不同的腹腔镜技术在围手术期参数或功能结果方面无差异。
腹腔镜单纯前列腺切除术相对于开放技术具有内在优势。需要进一步研究以确定对于因过大而无法安全进行内镜切除的前列腺腺瘤，该技术是否应被视为首选治疗方法。
