[1]杨旭 周凯 李梦强 李永生*.腹腔镜根治性膀胱前列腺切除术治疗前列腺癌广泛侵及膀胱6例报告[J].中国微创外科杂志,2022,01(8):662-666.
　Yang Xu,Zhou Kai,Li Mengqiang,et al.Laparoscopic Radical Cystoprostatectomy for Prostate Cancer With Extensive Invasion of Bladder: Report of 6 Cases[J].Chinese Journal of Minimally Invasive Surgery,2022,01(8):662-666.
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腹腔镜根治性膀胱前列腺切除术治疗前列腺癌广泛侵及膀胱6例报告()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2022年8期
页码:
662-666
栏目:
经验交流
出版日期:
2022-11-25

文章信息/Info

Title:
Laparoscopic Radical Cystoprostatectomy for Prostate Cancer With Extensive Invasion of Bladder: Report of 6 Cases
作者:
杨旭 周凯 李梦强 李永生*
(福建医科大学附属协和医院泌尿外科，福州350001)
Author(s):
Yang Xu;  Zhou Kai;  Li Mengqiang;  et al.
Department of Urology, Fujian Medical University Union Hospital, Fuzhou 350001, China
关键词:
前列腺癌; 膀胱前列腺切除术; 腹腔镜
Keywords:
Prostate cancer; Radical cystoprostatectomy; Laparoscope
文献标志码:
B
摘要:
目的探讨腹腔镜根治性膀胱前列腺切除术治疗前列腺癌广泛侵犯膀胱的疗效。方法2015年12月~2019年6月我们对6例前列腺癌广泛侵及膀胱行腹腔镜下根治性膀胱前列腺切除及尿流改道手术，采用经腹腔入路五孔法，游离输尿管中下段至膀胱壁外，由髂总动脉分叉处开始，清扫两侧髂外动脉旁淋巴结、闭孔淋巴结和髂内动脉旁淋巴结，游离输精管、精囊及前列腺后面，游离膀胱前壁，缝扎阴茎背深静脉复合体，游离膀胱侧韧带及前列腺侧韧带，离断尿道，在腹腔镜下完成膀胱前列腺切除和淋巴结清扫，后距回盲处近端约20 cm处取长约15 cm回肠，体外构建流出道。术后均行辅助内分泌治疗。结果6例腹腔镜下根治性膀胱前列腺切除联合回肠膀胱通道术顺利完成，无中转开放手术及输血。手术时间(322.5±41.2)min，术后住院时间(10.8±2.5)d，无Ⅲ级及以上并发症。术后切缘阳性4例，淋巴结阳性4例；术后病理分期T4N1M0期4例，T4N0M0期2例。术后局部症状改善明显，局部症状评分平均0.5分（0~1分），低于术前（平均3.2分）。术后1个月血肌酐(109.8±23.7)mmol/L。6例中位随访45(30~72)个月，1例死于心脏疾病，2例PSA进展，辅助放疗及多西他赛治疗，3例未见复发或转移。结论腹腔镜根治性膀胱前列腺切除术可作为前列腺癌广泛累及膀胱的一种治疗选择，能改善患者局部症状。
Abstract:
ObjectiveTo evaluate the efficacy of laparoscopic radical cystoprostatectomy in the treatment of prostate cancer with extensive bladder invasion.MethodsClinical data of 6 patients with prostate cancer with extensive bladder invasion who were treated with laparoscopic radical cystoprostatectomy and urinary diversion in our hospital from December 2015 to June 2019 were retrospectively analyzed. The operation was performed by 5hole transperitoneal approach to free the middle and lower ureters outside the bladder wall. Starting from the bifurcation of the common iliac artery, we cleaned the lymph nodes near the external iliac artery, obturator lymph nodes and paraarterial lymph nodes of internal iliac artery on both sides, dissected the vas deferens, seminal vesicles, back of the prostate, and anterior wall of the bladder. The deep dorsal vein complex of the penis was sutured, and the lateral bladder ligament and the lateral prostate ligament were freed. The urethra was severed. Cystoprostatectomy and lymph node dissection were completed under laparoscopy, and the ileum was taken about 15 cm long from the place about 20 cm away from the proximal ileocecal part. The outflow tract was constructed in vitro. All the patients were treated with androgen deprivation therapy.ResultsAll the 6 patients underwent laparoscopic radical cystoprostatectomy and ileal conduit. The operations were successfully completed without conversion to open surgery or blood transfusion. The operation time was (322.5±41.2) min, the postoperative hospital stay was (108±2.5) d, and there were no grade Ⅲ or above complications. There were 4 cases of positive postoperative resection margin and 4 cases of positive lymph node. The postoperative pathological staging showed T4N1M0 in 4 cases and T4N0M0 in 2 cases. The local symptoms improved significantly after operation. The mean local symptom score was 0.5 points (range, 0-1 points), which was lower than preoperation (mean, 3.2 points). The creatinine level was (109.8±23.7) mmol/L at 1 month after operation. All the 6 patients were followed up for a median of 45 months (range, 30-72 months). One patient died of heart disease, two patients had PSA progression, treated with adjuvant radiotherapy and docetaxel treatment, and three patients did not have recurrence or metastasis.ConclusionLaparoscopic radical cystoprostatectomy can be used as a treatment option for prostate cancer with extensive bladder involvement and can improve local symptoms in patients.

参考文献/References:

[1]Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin,2021,71(3):209-249.
[2]Chen R, Ren S, Yiu MK, et al. Prostate cancer in Asia：a collaborative report. Asian J Urol,2014,1(1):15-29.
[3]王嘉毅，薛蔚.前列腺癌新辅助治疗研究进展.中华泌尿外科杂志,2020,41(6)：477-480.
[4]Hajili T, Ohlmann CH, Linxweiler J, et al. Radical prostatectomy in T4 prostate cancer after inductive androgen deprivation：results of a singleinstitution series with longterm followup. BJU Int,2019,123(1):58-64.
[5]Johnstone PA, Ward KC, Goodman M, et al. Radical prostatectomy for clinical T4 prostate cancer. Cancer,2006,106(12):2603-2609.
[6]Cooperberg MR, Cowan J, Broering JM, et al. Highrisk prostate cancer in the United States, 1990-2007. World J Urol,2008,26(3):211-218.
[7]Won AC, Gurney H, Marx G, et al. Primary treatment of the prostate improves local palliation in men who ultimately develop castrateresistant prostate cancer. BJU Int,2013,112(4):E250-E255.
[8]Epstein JI, Egevad L, Amin MB,et al. The 2014 International Society of Urological Pathology (ISUP) consensus conference on Gleason grading of prostatic carcinoma: Definition of grading patterns and proposal for a new grading system. Am J Surg Pathol,2016,40(2):244-252.
[9]刘定益,胡桑,楚晨龙,等.微创经尿道前列腺等离子电切术联合内分泌治疗高龄晚期前列腺癌合并尿潴留.中国微创外科杂志,2017,17(10):919-921.
[10]Fowler JE Jr, Bigler SA, White PC, et al. Hormone therapy for locally advanced prostate cancer. J Urol,2002,168(2):546-549.
[11]Paul AB, Love C, Chisholm GD. The management of bilateral ureteric obstruction and renal failure in advanced prostate cancer. Br J Urol,1994,74(5):642-645.
[12]Spahn M, Briganti A, Capitanio U, et al. Outcome predictors of radical prostatectomy followed by adjuvant androgen deprivation in patients with clinical high risk prostate cancer and pT3 surgical margin positive disease. J Urol,2012,188(1):84-90.
[13]Nelson JB. The ongoing challenge of urinary incontinence after radical prostatectomy. J Urol,2017,198(6):1223-1225.
[14]Naccarato A, Consuelo Souto S, Matheus WE, et al. Quality of life and sexual health in men with prostate cancer undergoing radical prostatectomy. Aging Male,2020,23(5):346-353.
[15]Kim AH, Konety B, Chen Z, et al. Comparative effectiveness of local and systemic therapy for T4 prostate cancer. Urology,2018,120:173-179.
[16]Maroni PD. Is radical prostatectomy appropriate for veryhighrisk prostate cancer patients? Yes. Oncology(Williston Park),2015,29(5):348,388.
[17]Ward J, Sebo T, Blute M, et al. Salvage surgery for radiorecurrent prostate cancer: contemporary outcomes. J Urol,2005,173(4):1156-1160.
[18]Mano R, Goldberg H, Stabholz Y, et al. Urinary tract infections after urinary diversiondifferent occurrence patterns in patients with ileal conduit and orthotopic neobladder. Urology,2018,116:87-92.

备注/Memo

备注/Memo:
*通讯作者，Email：Lysdr163@163.com
更新日期/Last Update: 2022-11-25