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[前列腺癌手术:技术原则与围手术期并发症]

[Surgery of prostate cancer: Technical principles and perioperative complications].

作者信息

Salomon L, Rozet F, Soulié M

机构信息

Service d'urologie et de transplantation rénale et pancréatique, CHU Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France.

Service d'urologie, institut mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France.

出版信息

Prog Urol. 2015 Nov;25(15):966-98. doi: 10.1016/j.purol.2015.08.008.

Abstract

OBJECTIVE

To describe the surgical procedure of localized prostate cancer treated by radical prostatectomy.

MATERIAL AND METHOD

Bibliography search was performed from the Medline database (National Library of Medicine, PubMed) selected according to the scientific relevance. The research was focused on historic of radical prostatectomy, surgical anatomy, surgical technics of radical prostatectomy and lymph nodes excision, and complications.

RESULTS

During the last 30 years, evolution of radical prostatectomy was important, from open to mini-invasive surgery with or without robotic assistance. Anatomical knowledge of the prostate was useful to describe the different anatomical structure as urinary sphincter and fascias, and to develop different procedure of neurovascular bundles preservation to ameliorate functional results. Complications are well-known and their taking-over more precise. Results of radical prostatectomy depend less of the surgical approach but more of the attitude of the surgeon according to the characteristics of the tumor and the functional status of the patient.

CONCLUSION

Radical prostatectomy is an elaborate and challenging procedure when carcinological risk balances with functional results. Nevertheless, complications are quite rare. Improvement of results is due to adequation between surgical procedure and oncological and functional status.

摘要

目的

描述根治性前列腺切除术治疗局限性前列腺癌的手术过程。

材料与方法

根据科学相关性从美国国立医学图书馆的Medline数据库(PubMed)进行文献检索。研究重点在于根治性前列腺切除术的历史、手术解剖学、根治性前列腺切除术及淋巴结切除术的手术技术以及并发症。

结果

在过去30年中,根治性前列腺切除术发生了重大演变,从开放手术发展到有或无机器人辅助的微创手术。前列腺的解剖学知识有助于描述不同的解剖结构,如尿道括约肌和筋膜,并开发不同的保留神经血管束的手术方法以改善功能结果。并发症是众所周知的,且对其处理更为精确。根治性前列腺切除术的结果较少取决于手术方式,而更多取决于外科医生根据肿瘤特征和患者功能状态所采取的态度。

结论

当肿瘤学风险与功能结果相平衡时,根治性前列腺切除术是一个精细且具有挑战性的手术。然而,并发症相当罕见。结果的改善归因于手术过程与肿瘤学和功能状态之间的匹配。

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