Lavery Hugh J, Senaratne Prathibha, Gainsburg Daniel M, Samadi David B
Department of Urology, The Mount Sinai Medical Center, New York, New York, USA.
JSLS. 2010 Jul-Sep;14(3):439-41. doi: 10.4293/108680810X12924466007287.
Given the rich blood supply to the prostate and the adjacent Santorini's plexus, radical prostatectomy is associated with significant blood loss even in patients with normal coagulation profiles. In patients with hemophilia, any surgical procedure carries a risk of significant hemorrhage due to a deficiency of factors in the coagulation cascade. For these reasons, hemophiliac patients have often been encouraged to undergo radiation or other forms of nonsurgical treatment for clinically localized prostate cancer. However, the decreased blood loss associated with a laparoscopic/robotic approach and appropriate perioperative factor transfusions can minimize the risk of hemorrhage during robotic-assisted radical prostatectomy. We present the case report of a successful robotic-assisted laparoscopic prostatectomy in a patient with mild hemophilia A, with an estimated blood loss for the procedure of 20 mL. We will focus on the perioperative management of the patient's factor replacement.
鉴于前列腺丰富的血液供应以及临近的Santorini静脉丛，即使凝血功能正常的患者，根治性前列腺切除术也会导致大量失血。对于血友病患者，由于凝血级联反应中某些因子缺乏，任何外科手术都有发生大出血的风险。出于这些原因，通常鼓励血友病患者对临床局限性前列腺癌采用放疗或其他非手术治疗方式。然而，腹腔镜/机器人手术方式以及适当的围手术期因子输注所带来的失血量减少，可将机器人辅助根治性前列腺切除术中出血的风险降至最低。我们报告一例成功为轻度甲型血友病患者实施机器人辅助腹腔镜前列腺切除术的病例，该手术估计失血量为20毫升。我们将重点关注该患者围手术期的因子替代治疗管理。
