腹腔镜耻骨后尿道外腺瘤切除术

S. Eremenko, A. Eremenko, V. Mykhaylichenko, V. Dolgopolov, V. Chernega, A. S. Khalilova
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Based on St. Luke’s Simferopol сlinical Multidisciplinary Medical Center, 35 successful laparoscopic operations were performed to remove benign prostate hyperplasia with the prostatic urethra preservation. The features of the operation are laparoscopic access, a transverse section of the capsule, alternate isolation of adenomatous nodes while preserving the prostatic urethra on the catheter without replacing it during the operation, suturing the capsule with a decrease in space from the removed adenomatous nodes. Urethral preservation provided accelerated epithelialization of the defect, in the absence of the formation of a “prevesical” space.Results. After the operation, it is possible to turn off the urinary bladder irrigation system earlier (up to 4 – 6 hours after the operation) and early removal of the catheter after surgery (2 – 3 days). The hospital stay averaged 5.7 days. Urination was restored immediately after catheter removal in 92% of the patients. 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摘要

介绍。良性前列腺增生的现有手术治疗方法常伴有术后并发症的发生,如尿失禁、逆行射精、尿道狭窄等。保存前列腺尿道的方法已经发展了很长时间。目前,应用手术技术进行腹腔镜保留尿道腺瘤切除术是可行的。探讨腹腔镜下保留前列腺尿道行尿道外腺瘤切除术的可行性及其优缺点。材料和方法。本文基于圣路加辛菲罗波尔临床多学科医学中心,成功施行35例保留前列腺尿道的腹腔镜下良性前列腺增生切除手术。手术的特点是腹腔镜下进入,囊的横切面,交替隔离腺瘤淋巴结,同时保留导管上的前列腺尿道,术中不更换导管,缝合囊与切除的腺瘤淋巴结之间的空间减小。在没有形成“前膀胱”空间的情况下,尿道保留可加速缺损的上皮化。术后可提前(术后4 - 6小时)关闭膀胱冲洗系统,术后2 - 3天早期拔除导尿管。平均住院时间为5.7天。92%的患者在拔管后立即恢复排尿。没有排尿困难的症状,特别是尿失禁。术后经直肠超声摄护腺体积为20 ~ 24 cm³。保留前列腺尿道的耻骨后尿道外腺瘤切除术可以在腹腔镜下进行。其优点是患者早期激活和出院,早期拔除导管恢复独立排尿,无排尿困难、尿失禁和术后并发症。我们的研究结果证明了腹腔镜尿道外腺瘤切除术技术的有效性,该技术的进一步发展,以及在实践中应用的可能性。
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Laparoscopic retropubic extraurethral adenomectomy
Introduction. Existing methods of surgical treatment of benign prostatic hyperplasia are accompanied by the frequent development of postoperative complications, such as urinary incontinence, retrograde ejaculation, and urethral strictures. The method of preserving the prostatic urethra has been developed for a long time. At present, it is possible to use the operation technique and perform laparoscopic urethral-sparing adenomectomy.Objective. To assess the possibility of performing extraurethral adenomectomy with prostatic urethral preservation using the laparoscopic approach, its advantages and disadvantages.Materials and methods. Based on St. Luke’s Simferopol сlinical Multidisciplinary Medical Center, 35 successful laparoscopic operations were performed to remove benign prostate hyperplasia with the prostatic urethra preservation. The features of the operation are laparoscopic access, a transverse section of the capsule, alternate isolation of adenomatous nodes while preserving the prostatic urethra on the catheter without replacing it during the operation, suturing the capsule with a decrease in space from the removed adenomatous nodes. Urethral preservation provided accelerated epithelialization of the defect, in the absence of the formation of a “prevesical” space.Results. After the operation, it is possible to turn off the urinary bladder irrigation system earlier (up to 4 – 6 hours after the operation) and early removal of the catheter after surgery (2 – 3 days). The hospital stay averaged 5.7 days. Urination was restored immediately after catheter removal in 92% of the patients. There were no elements of dysuria, particularly urinary incontinence. Prostate volume measured throughout transrectal ultrasound after operation was 20 – 24 cm³.Conclusion. The technique of retropubic extraurethral adenomectomy with prostatic urethral preservation can be performed in laparoscopic technique. The advantages are early activation of the patient and discharge from the hospital, early removal of the catheter with restoration of independent urination, absence of dysuria, urinary incontinence, and postoperative complications. The results of our study demonstrate the effectiveness of the laparoscopic extraurethral adenomectomy technique, the further development of this technique, and the possibility of its application in practice.
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