Katz Ran, Borkowski Tomasz, Hoznek Andras, Salomon Laurent, Gettman Matthew T, Abbou Clement Claude
Service d'Urologie, CHU Henri-Mondor, Creteil, France.
Urol Int. 2006;77(3):216-21. doi: 10.1159/000094812.
Previous transurethral resection of the prostate (TURP) was reported to impose difficulties during open radical prostatectomy. We describe our experience in laparoscopic radical prostatectomy (LRP) following transurethral resection of the prostate.
The series included 35 patients: 22 patients underwent transperitoneal LRP (tpLRP) and 13 underwent extraperitoneal LRP (epLRP). The minimal interval between TURP and laparoscopy was 3 months. Patients' charts were reviewed for their preoperative characteristics, intraoperative difficulties and complications, and outcome.
Patients' mean age was 67.5+/-4.4 years. 12 patients were cT1a,b and 23 patients were cT1c/T2. Twenty-two patients underwent tpLRP and 13 underwent epLRP. No statistical difference was found between the preoperative characteristics and the pathological results of cT1a,b vs. T1c/cT2 patients, or tpLRP vs. epLRP patients. Thirty-three procedures were completed laparoscopically and 2 were converted to open surgery. Perioperative complications included two leaking anastomoses, prolonged lymph drainage in 1 case, atelectasis (n=1) and duodenal ulcer (n=1). Twelve positive margins were noted, half of them in pT2 tumors. The mean follow-up was 28.5 months. Twenty-five of 35 patients had more than 12 months of follow-up. Among them 19 patients were completely continent (76%) and 6 (24%), reported mild stress incontinence.
Although LRP following TURP is sometimes more technically difficult, simple modifications in the operative strategy help facilitate surgery. LRP following TURP favorably compares to open radical prostatectomy after TURP and laparoscopy in non-TURP patients.
据报道，既往经尿道前列腺切除术（TURP）会给开放性根治性前列腺切除术带来困难。我们描述了我们在经尿道前列腺切除术后行腹腔镜根治性前列腺切除术（LRP）的经验。
该系列包括35例患者：22例接受经腹LRP（tpLRP），13例接受腹膜外LRP（epLRP）。TURP与腹腔镜检查之间的最短间隔为3个月。回顾患者病历以了解其术前特征、术中困难及并发症和结局。
患者平均年龄为67.5±4.4岁。12例为cT1a、b期，23例为cT1c/T2期。22例患者接受tpLRP，13例接受epLRP。cT1a、b期与T1c/cT2期患者，或tpLRP与epLRP患者的术前特征和病理结果之间未发现统计学差异。33例手术通过腹腔镜完成，2例转为开放手术。围手术期并发症包括2例吻合口漏、1例淋巴引流延长、1例肺不张和1例十二指肠溃疡。发现12例切缘阳性，其中一半在pT2肿瘤中。平均随访时间为28.5个月。35例患者中有25例随访超过12个月。其中19例患者完全控尿（76%），6例（24%）报告有轻度压力性尿失禁。
虽然TURP术后行LRP有时在技术上更具挑战性，但手术策略的简单调整有助于手术顺利进行。TURP术后行LRP与TURP术后行开放性根治性前列腺切除术以及非TURP患者行腹腔镜检查相比具有优势。
