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目的总结经耻骨后前列腺癌根治术的治疗体会。方法2000年-2005年27例局限性前列腺癌患者,年龄60-71岁,平均66岁,术前PSA值4.8-37.5 ng/mL。B期21例,G1期6例。采用开放性前列腺癌根治术治疗。结果本组患者高分化癌7例,中分化癌15例,低分化癌5例,术中出血300-1 200 mL,平均560 mL,无周围脏器损伤及围手术期死亡病例,无吻合口漏尿。无吻合口狭窄、排尿困难,6例出现暂时性尿失禁,分别于术后1-2月恢复。9例术后1个月PSA降为0,随访未见升高,无需服用抗雄激素药物;其余18例患者间断性服用抗雄激素药物PSA下降至0.2 ng/mL。术后16例维持阴茎勃起功能,所有病例均无瘤存活。结论耻骨后前列腺癌根治术中保留耻骨前列腺韧带及耻骨直肠悬带有助于减少并发症,取得较好的疗效。
Objective To summarize the experience of radical prostatectomy after retropubic surgery. Methods From 2000 to 2005, 27 patients with localized prostate cancer, aged 60-71 years (mean, 66 years) with preoperative PSA of 4.8-37.5 ng / mL. 21 cases in stage B and 6 cases in stage G1. The use of open radical prostatectomy treatment. Results The patients with well-differentiated carcinoma in 7 cases, 15 cases of moderately differentiated carcinoma, poorly differentiated carcinoma in 5 cases, intraoperative bleeding 300-1 200 mL, average 560 mL, no peripheral organ damage and perioperative deaths, no anastomosis Leak urine. No anastomotic stenosis, dysuria, 6 cases of temporary urinary incontinence, respectively, after 1 to 2 months to recover. PSA was reduced to 0 in 9 cases at one month after operation. No increase was observed during the follow-up period. Anti-androgen drugs were not needed in the follow-up. The PSA in the remaining 18 patients dropped to 0.2 ng / mL. After operation, 16 cases maintained penile erection, and no tumor survived in all cases. Conclusions The preservation of pubopulmonary prosthesis and puborectalis sling in radical retropubic prostatectomy can reduce the complication and achieve better curative effect.