| Background and PurposeRadical prostatectomy has become the gold standard surgical treatment for localized prostate cancer.Since the 1990s in the early detection of serum PSA are widely used in clinical practice,more and more patients with prostate cancer can be diagnosed early.Prostate cancer surgery surgical skills through the long course of developmerit,so far,has matures.Schuessler reports of the first case of laparoscopic radical prostatectomy(LRP) in the 1992,"laparoscopic radical prostatectomy is feasible but currently offers no advantage over open surgery with regard to tumor removal,continence,potency, length of stay,convalescence,and cosmetic result".France and others Guillonneau standardized method of laparoscopic surgery.Through continuous improvements of technology and equipment,LRP surgery has gradually improved and recognized, become one of the choices for localized prostate cancer.Binder in the 2001 reports of the first robot-assisted LRP,and subsequently the United States Detroit Vattikuti Institute have built a perfect robot-assisted technology,"Vattikuti Institute prostatectomy"(VIP),they made a total of more than 2,600 Cases of robot-assisted LRP from 2001 to 2006,and the results have advantages of oncologic and functional outcomes than open radical prostatectomy.The purpose of this study through laparoscopic radical prostatectomy surgery and open surgery,the evaluation of their clinical value. MethodsFrom February 2004 to December 2007,we have 15 cases of TNM staging pT1c-pT3a,Gleason score≤7 patients with prostate cancer,the use of intraperitoneal approach for laparoscopic radical prostatectomy and the opening up of the radical retropubic prostatectomy for the treatment,by the patient's clinical data were analyzed retrospectively,the laparoscopic surgery group(LRP)and the open surgery group (ORP),the operative time,intraoperative blood loss,transfusion rate,postoperative pain,The incidence of postoperative urinary leakage,Postoperative pain,the number of hospitalization days were compared;and patients with long-term follow-up, compared between the two groups of postoperative incontinence,bladder neck stricture rate,detectable prostate-specific antigen after operation.All data were passed SPSS 16.0 professional statistical software based on different situations T- test analysis,P<0.05 for the difference statistically significant.ResultsFrom February 2004 to December 2007,we conducted a total of 10 cases of laparoscopic radical prostatectomy,have been successful,no one cases to open surgery.The average operative time was 358.00±139.37min,bleeding of 1101.00±1246.24ml,after removal of the time with abdominal conduct 4.60±3.86 days,the uprooting of catheter time 13.80±6.07 days,the number of days hospitalized after 14.10±7.52 days,blood transfusion 5 Cases,1,3,7,14 days postoperative pain score (visual analogue scale(VAS))were 3.80±1.87,1.90±0.57,1.40±0.70,0.50±0.71 points,two cases of leakage of urine,blood PSA 1.03±1.59 ng / ml after 3 months, one case of urinary incontinence,bladder neck stenosis in 1 case.One of them appeared obturator nerve injury(at the left obturator lymph node dissection of the ultrasonic scalpel cut half),with one week after the left lower extremity numbness, gradual return after 1 month.From July 2004 to December 2007,we conducted a total of five cases of open radical prostatectomy,have been successful.The average operative time was 194.00±80.89min,bleeding of 1860.00±1561.41ml,after removal of the time with abdominal 6.60±2.07 days,the uprooting of catheter time 17.40±6.88 days,the number of days hospitalized after 23.00±9.11 days,blood transfusion 5 Cases,1,3,7,14 days postoperative pain score(visual analogue scale(VAS))were 4.80±1.92,3.00 1.23,1.80±±1.10 points 0.84,1.80,three cases of leakage of urine,blood PSA 0.83±0.81ng/ml after 3 months,one case of urinary incontinence,bladder neck stenosis in 1 case.We conducted by the 15 cases were successful surgery without the rectum, bladder,ureter,and other injuries;patients without lymphatic fistula,deep vein thrombosis,a serious pulmonary embolism,and myocardial infarction,and other major complications occurred,Surgical margins were negative.Conclusions.Our research results show that the intraperitoneal approach for laparoscopic radical prostatectomy in the treatment of localized prostate cancer,safe and effective; and compared with traditional open surgery,both oncologic and functional results are similar,laparoscopic radical prostatectomy surgery for a less bleeding,small incision, reduced surgery trauma patients recovered quickly after surgery,less pain,earlier activities,the advantages of early extubation time,etc. |
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