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耻骨后入路根治性前列腺切除术的发病率:150例病例系列

[The morbidity of radical prostatectomy using a retropubic approach: a series of 150 cases].

作者信息

Bretheau D, Bochereau G, Veillon B, Brisset J M, Vallancien G

机构信息

Département d'Urologie, C.M.C. de la Porte de Choisy, Paris.

出版信息

Prog Urol. 1994 Aug-Sep;4(4):523-31.

PMID:7920728
Abstract

The authors studied the morbidity of retropubic radical prostatectomy in 150 patients operated between December 1983 and March 1993. The perioperative mortality was zero. A rectal injury occurred in 3 cases (2%) and was repaired immediately without colostomy. The median operative blood loss was 1,500 ml. 36.6% of cases developed perioperative complications. 8% of early postoperative complications (< 1 month) required reoperation. Major complications (thromboembolic and septic) were observed in 3.2% of cases. The late postoperative complications included fibrous stenosis of the urethrovesical anastomosis in 12% of cases with a median time to onset of 4 months: 3.6% of patients developed an anastomotic stenosis due to local recurrence. 12.6% of cases developed persistent urinary incontinence (6.6% of minor incontinence, 5.3% of moderate incontinence and 0.7% of severe incontinence). Incontinence was more frequent (p < 0.05) among the first 75 patients of the series. Erectile function was preserved in 19.8% of patients. The incidence of post-operative impotence was significantly lower (p < 0.01) in patients under the age of 60 years (65% vs 94.8%). Radical prostatectomy, considered to be the most appropriate treatment for localised prostatic cancer, can now be performed with acceptable morbidity.

摘要

作者研究了1983年12月至1993年3月期间接受耻骨后根治性前列腺切除术的150例患者的发病情况。围手术期死亡率为零。3例(2%)发生直肠损伤,均立即进行修复,未行结肠造口术。术中中位失血量为1500毫升。36.6%的病例发生围手术期并发症。8%的术后早期并发症(<1个月)需要再次手术。3.2%的病例出现严重并发症(血栓栓塞和感染)。术后晚期并发症包括12%的病例发生尿道膀胱吻合口纤维性狭窄,中位发病时间为4个月:3.6%的患者因局部复发出现吻合口狭窄。12.6%的病例出现持续性尿失禁(轻度尿失禁占6.6%,中度尿失禁占5.3%,重度尿失禁占0.7%)。该系列的前75例患者中尿失禁更为常见(p<0.05)。19.8%的患者保留了勃起功能。60岁以下患者术后阳痿的发生率显著较低(p<0.01)(65%对94.8%)。根治性前列腺切除术被认为是局限性前列腺癌最合适的治疗方法,目前其发病率是可以接受的。

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