论文部分内容阅读
目的探讨达.芬奇(Da Vinci)机器人辅助腹腔镜前列腺根治性切除术治疗高龄高危前列腺癌患者的可行性和效果。方法患者,男性,82周岁。超声显示“前列腺47mm×42mm×41mm,内部回声不均匀”。治疗前PSA11.9ng/ml,F-PSA1.43ng/ml。临床诊断为T3a(直肠指检前列腺可扪及硬结),前列腺穿刺活组织病理检查确诊为前列腺癌,Gleason评分为7分。盆腔CT扫描未见周围组织侵犯。2010年4月我们对该患者实施了Da Vinci机器人辅助腹腔镜前列腺根治性切除术,直视下行6套管法建立通道,Da Vinci机器人辅助腹腔镜下依次行双侧闭孔淋巴结清扫、前列腺切除、精囊切除、尿道吻合重建。观察手术时间、术中失血量、输血情况、引流管及导尿管留置时间、术后并发症及手术效果。结果手术时间270min(包括体位摆放及Da Vinci机器人到位30min),手术失血量1200ml,输红细胞3U,血浆300ml。术后无尿漏,第5天拔除左侧引流管,第6天拔除右侧引流管。术后病理报告“前列腺腺癌,Gleason评分3+4=7分,精囊未受侵犯”。术后1周查PSA0.17ng/ml。术后3周拔除导尿管,可自行排尿,尿控良好。结论 Da Vinci机器人辅助腹腔镜前列腺癌根治术更加微创,适合于高龄高危前列腺癌患者,一般而言年龄不应成为前列腺癌根治术的禁忌,但须充分关注手术的潜在风险并及时处理。
Objective To investigate the feasibility and effect of Da Vinci robot assisted laparoscopic radical prostatectomy in the treatment of elderly and at-risk prostate cancer. Methods Patients, male, 82 years of age. Ultrasound showed “prostate 47mm × 42mm × 41mm, internal echo uneven”. Before treatment PSA11.9ng / ml, F-PSA1.43ng / ml. Clinical diagnosis of T3a (rectal palpable prostate palpable induration), prostate biopsy biopsy diagnosed as prostate cancer, Gleason score of 7 points. No pelvic CT scan violations of surrounding tissue. In April 2010, we performed a Da Vinci robotic-assisted radical laparoscopic radical prostatectomy in April 2010. We underwent direct laryngectomy through 6 cannulas. Da Vinci robotic assisted laparoscopic biopsy of bilateral closed-cell lymph nodes followed by prostatectomy , Seminal vesicle resection, urethral anastomosis reconstruction. The operation time, intraoperative blood loss, blood transfusion, drainage tube and catheter retention time, postoperative complications and surgical effects were observed. Results The operation time was 270 min (including the position display and Da Vinci robot in place for 30 min). The blood loss of operation was 1200 ml, 3U transfused erythrocytes and 300 ml plasma. Urine leakage after surgery, the fifth day of removal of the left drainage tube, the sixth day of removal of the right drainage tube. Postoperative pathology report “Prostate adenocarcinoma, Gleason score 3 + 4 = 7 points, seminal vesicle unscathed.” One week after surgery, PSA0.17ng / ml. 3 weeks after removal of the catheter, urinating on their own, good urine control. Conclusions Da Vinci robotic assisted laparoscopic radical prostatectomy is more minimally invasive and suitable for elderly patients with high-risk prostate cancer. In general, age should not be a taboo for radical prostatectomy. However, adequate attention should be paid to the potential risks of surgery and prompt treatment.