Salomon L, Colombel M, Patard J J, Contremoulins I, Bellot J, Lefrére-Belda M A, Gasman D, Chopin D, Abbou C C
Service d'Urologie, Hôpital Henri Mondor, Créteil, France.
Prog Urol. 1997 Dec;7(6):976-83.
Two surgical approaches are proposed for radical prostatectomy: the retropubic route and the perineal route. We compared the surgical, oncological and functional aspects of these two approaches and present arguments suggesting that the perineal approach is the preferred approach for radical prostatectomy.
55 retropubic radical prostatectomies were retrospectively compared to 55 perineal radical prostatectomies and performed between March 1992 to December 1995. The clinical TNM, preoperative PSA, results of 6 systematized intrarectal biopsies, operating time, intraoperative bleeding, number of patients transfused and number of packed cell units per patient transfused, medical and surgical complications, catheterization time and length of hospital stay, incidence of urethrovesical anastomosis leak and stenosis, analysis of the prostatectomy specimen, course of PSA, continence and erection were studied.
Statistically significant differences were observed for the retropubic and perineal approaches, respectively: preoperative PSA (24 vs 15 ng/mL), intraoperative bleeding (2664 vs 1071 mL), number of patients transfused (91% vs 28%), number of packed cell units per patient transfused (3.9 vs 2.7), medical and surgical complications (56.9 vs 29.1%), anastomotic leak (24.1 vs 7.2%), anastomotic stenosis (31.5 vs 1.8%), duration of catheterization (18 vs 13 days) and length of hospital stay (14 vs 8 days). At 2 years, PSA remained less than 0.5 ng/mL in both groups.
Even taking the learning period into account, the perineal approach provides the same results as the retropubic approach in terms of functional and oncological parameters, with a simpler postoperative course for patient.
根治性前列腺切除术有两种手术入路：耻骨后途径和会阴途径。我们比较了这两种入路在手术、肿瘤学及功能方面的情况，并提出论据表明会阴入路是根治性前列腺切除术的首选入路。
回顾性比较了1992年3月至1995年12月期间进行的55例耻骨后根治性前列腺切除术和55例会阴根治性前列腺切除术。研究了临床TNM分期、术前前列腺特异性抗原（PSA）、6次系统性直肠内活检结果、手术时间、术中出血情况、输血患者数量及每位输血患者的红细胞压积单位数量、内科及外科并发症、导尿时间及住院时间、尿道膀胱吻合口漏及狭窄的发生率、前列腺切除标本分析、PSA变化过程、控尿及勃起情况。
耻骨后和会阴入路分别观察到具有统计学意义的差异：术前PSA（24对15 ng/mL）、术中出血（2664对1071 mL）、输血患者数量（91%对28%）、每位输血患者的红细胞压积单位数量（3.9对2.7）、内科及外科并发症（56.9%对29.1%）、吻合口漏（24.1%对7.2%）、吻合口狭窄（31.5%对1.8%）、导尿持续时间（18对13天）及住院时间（14对8天）。两组在2年时PSA均保持低于0.5 ng/mL。
即使考虑到学习阶段，会阴入路在功能和肿瘤学参数方面与耻骨后入路效果相同，且患者术后恢复过程更简单。
