论文部分内容阅读
目的探讨腹腔镜前列腺癌根治术后吻合口尿漏的防治方法。方法自2006年1月至2011年1月,我院行腹腔镜前列腺癌根治术151例,其中采取双针连续尿道膀胱吻合法58例、传统尿道膀胱缝合法93例。出现持续性尿道膀胱吻合口尿漏8例(5.3%,8/151),平均年龄66(53～78)岁;术前总前列腺特异抗原(T-PSA)平均34.3(1.1～165.0)ng/ml;Gleason评分<7分4例、7分2例、>7分2例;TNM T1c5例、T2a2例、T2c1例;平均手术时间202(60～360)min;均采用调整导尿管位置、持续低张力牵拉导尿管,并保持导尿管、耻骨后引流管通畅,预防感染、减少液体摄入量,同时加强营养等保守处理方法。保守治疗失败的病例,行腹腔镜下吻合口尿漏修补。结果采取双针连续尿道膀胱吻合法的病例,均未出现持续性吻合口尿漏,明显优于传统法缝合组[0vs 8.6%(8/93),P<0.05]。6例经保守处理治愈,2例行腹腔镜下吻合口尿漏修补治愈。平均33(21～43)d拔除导尿管,术后平均随访39(22～60)个月,无尿道狭窄发生。结论采取双针连续尿道膀胱吻合法可以有效防止吻合口尿漏的发生,保守治疗、腹腔镜下修补是处理术后持续性吻合口尿漏的有效方法。
Objective To investigate the prevention and treatment of anastomotic leakage after laparoscopic radical prostatectomy. Methods From January 2006 to January 2011, our hospital laparoscopic radical prostatectomy 151 cases, including 58 cases of double needle urethral anastomosis and traditional urethral bladder suture method in 93 cases. There were 8 cases (5.3%, 8/151) of urinary leakage of persistent urethral anastomosis, with an average age of 66 (53-78) years. Preoperative total prostate specific antigen (T-PSA) ml; Gleason score <7 points in 4 cases, 7 points in 2 cases,> 7 points in 2 cases; TNM T1c5 cases, T2a2 cases, T2c1 cases; average operation time 202 (60 ~ 360) Continuous low tension pull the catheter, and keep the catheter, pubic drainage tube patency, prevent infection, reduce fluid intake, while strengthening nutrition and other conservative treatment methods. Cases of conservative treatment failure, laparoscopic anastomotic leakage repair. Results No case of persistent anastomotic leakage was found in cases of double anterior urethral anastomosis, which was significantly superior to the traditional suture group [0 vs 8.6% (8/93), P <0.05]. 6 cases were cured by conservative treatment, 2 cases were cured by laparoscopic anastomotic leakage repair. An average of 33 (21-43) days after removal of the catheter, the average follow-up of 39 (22-60) months, no urethral stricture. Conclusion The double needle urethral anastomosis can effectively prevent the occurrence of anastomotic leakage. Conservative treatment and laparoscopic repair are effective methods to treat persistent anastomotic leakage after operation.