Lerner S E, Fleischmann J, Taub H C, Chamberlin J W, Kahan N Z, Melman A
Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
Urology. 1994 Apr;43(4):493-8. doi: 10.1016/0090-4295(94)90238-0.
Despite many known advantages, the radical perineal prostatectomy (RPP) had fallen out of favor because of the need for a second incision for the regional lymph node dissection. Laparoscopic lymphadenectomy, however, provides an accurate and minimally invasive alternative to open lymph node dissection. Herein are reported the practical advantages of combining laparoscopic lymph node dissection (LPLND) with RPP.
Forty-nine patients with clinically localized carcinoma of the prostate were considered candidates for RPP using a modified Belt technique. Thirty-five patients underwent attempted LPLND and 31 of these patients subsequently underwent RPP; 14 patients underwent RPP alone. Variables examined included total operative time, transfusion requirement, length of hospital stay, continence, and potency.
The mean operative time for LPLND combined with RPP in 31 patients, including time for repositioning, was 4.5 hours (range 3.0 to 7.0 hours). Only 26 percent of the patients who underwent the combined approach required blood transfusions of which 75 percent received autologous units. Mean length of stay was six days, and laparoscopy did not contribute significantly to postoperative morbidity. Eighty-four percent of the patients are completely continent. Of 27 potent patients who underwent nerve-sparing surgery, 22 percent are potent and an additional 30 percent are sexually active with intracavernous pharmacotherapy. There were no perioperative deaths, 2 major complications, and 5 minor complications.
Laparoscopic techniques now permit the urologist to utilize the perineal approach, and its many advantages, to radical prostatic extirpation without the need for a formal abdominal incision. The minimal blood loss and low morbidity associated with laparoscopic pelvic lymphadenectomy combined with the radical perineal prostatectomy make this procedure an attractive alternative to the open retropubic approach for clinically localized prostatic adenocarcinoma.
尽管根治性会阴前列腺切除术（RPP）有诸多已知优势，但由于区域淋巴结清扫需要做第二个切口，该手术已不再受青睐。然而，腹腔镜淋巴结清扫术为开放性淋巴结清扫提供了一种准确且微创的替代方法。本文报告了将腹腔镜淋巴结清扫术（LPLND）与RPP相结合的实际优势。
49例临床局限性前列腺癌患者被认为适合采用改良的Belt技术进行RPP。35例患者尝试进行LPLND，其中31例随后接受了RPP；14例患者仅接受了RPP。检查的变量包括总手术时间、输血需求、住院时间、控尿能力和性功能。
31例接受LPLND联合RPP的患者，包括重新定位时间，平均手术时间为4.5小时（范围3.0至7.0小时）。接受联合手术的患者中只有26%需要输血，其中75%接受了自体输血。平均住院时间为6天，腹腔镜检查对术后发病率没有显著影响。84%的患者完全控尿。在27例接受保留神经手术的性功能正常患者中，22%性功能正常，另有30%通过海绵体内药物治疗有性活动。无围手术期死亡，2例严重并发症，5例轻微并发症。
腹腔镜技术现在使泌尿外科医生能够利用会阴入路及其诸多优势进行根治性前列腺切除术，而无需进行正式的腹部切口。腹腔镜盆腔淋巴结清扫术与根治性会阴前列腺切除术相结合，出血少、发病率低，使该手术成为临床局限性前列腺腺癌开放性耻骨后入路的有吸引力的替代方法。
