【根治性前列腺切除术:超声在随访中的作用】。

C Lozzi, S Annoscia, G Leva, D Tiranti, C Boccafoschi
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引用次数: 0

摘要

本文对前列腺癌不同分期根治性前列腺切除术的手术技术和适应证进行了简要的总结,并对其并发症和手术后遗症进行了描述。作者报告了一个简短的系列。共13例患者。1989年1月至1991年9月期间,他们因前列腺癌接受了根治性前列腺切除术。病理分期B1 6例,B2 2例,C1 4例,C2 1例。特别强调了超声在淋巴囊肿、盆腔血肿、吻合口尿漏等早期并发症的发现和随访中的作用。经直肠超声对膀胱尿道吻合口漏尿的检测尤其有用。将该技术与传统的膀胱尿道造影技术进行了比较,并讨论了两种技术的优缺点。根治性前列腺切除术后的并发症有吻合口狭窄、盆腔复发、淋巴结或实质转移、尿失禁。强调了经直肠超声在检测吻合口狭窄中的作用,特别是在排尿时进行的研究。经直肠超声对盆腔复发的检测不太满意,尤其是小于1cm的盆腔复发。在肿块较大的情况下,数字检查本身就是诊断。最后作者描述了作为根治性前列腺切除术并发症的尿失禁及其病因。本文特别介绍了Rocca Rossetti提出的膀胱尿道吻合术及其在术后尿失禁中的应用价值。作者报告了经直肠超声检查前列腺根治术后尿道横纹括约肌的结果及其功能。
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[Radical prostatectomy: role of ultrasonography in the follow-up].

After a brief summary about surgical technique of radical prostatectomy and its indications in the different stages of prostatic cancer, the Authors describe complications and surgical sequelae of this operation. The Authors report a brief series. It is composed with 13 patients. Their have been submitted to radical prostatectomy for prostatic cancer between January 1989 and September 1991. Pathological stage was B1 in 6 patients, B2 in 2 patients, C1 in 4 cases and C2 in 1. Particularly the role of ultrasonography in detection and follow-up of early complications such as lymphocele, pelvic hematoma and anastomotic urine leakage is stressed. Transrectal ultrasound is especially useful in the detection of urine leakage from vesico-urethral anastomosis. This technique is compared with traditional cystourethrography and advantages and disadvantages of the two techniques are discussed. Later complications of radical prostatectomy are anastomotic stenosis, pelvic recurrences, nodal or parenchymal metastasis, urinary incontinence. The role of transrectal ultrasound in the detection of anastomotic strictures is stressed, especially when the study is done during micturition. Transrectal ultrasound is not so satisfying in the detection of pelvic recurrences, especially if they are smaller than 1 cm. In case of large masses digital examination is diagnostic itself. At last the Authors describe urinary incontinence and its etiology as a complication of radical prostatectomy. Particularly a surgical technique for vesico-urethral anastomosis proposed by Rocca Rossetti and its value in post-operative continence is described. The Authors show the results of transrectal ultrasound in the detection of striated urethral sphincter and its function after radical prostatectomy.

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