Morbidity of laparoscopic radical prostatectomy: Summary of early multi-institutional experience in Japan
Morbidity of laparoscopic radical prostatectomy: Summary of early multi-institutional experience in Japan
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DOI：
10.1046/j.1442-2042.2003.00658.x
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发表时间：
2003-08-01
影响因子：
2.6
通讯作者：
Naito, S
中科院分区：
文献类型：
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作者：
Arai, Y;Egawa, S;Naito, S
目的：腹腔镜根治性直肠癌切除术正在世界范围内进行评估。本研究的目的是报告早期的多机构的经验，在Japan.Methods的程序：共148名男子被诊断为临床局限性前列腺癌进行腹腔镜根治性前列腺切除术在日本的七个不同的机构。回顾性分析早期并发症（术后30天内）和术后恢复情况。结果：手术时间167-925分钟，平均427分钟，中位手术时间403分钟。失血量范围为50至5000 mL（中位数，540;平均值，856）。55例患者（37.2%）共报告了66例并发症。148例患者中有25例（16.9%）出现术中并发症：10例直肠损伤（6.8%）; 5例膀胱损伤（3.4%）; 5例皮下气肿（3.4%）; 2例肠损伤（1.4%）; 1例大血管损伤（0.7%）; 1例输尿管损伤（0.7%）; 1例闭孔神经损伤（0.7%）。总体而言，148例患者中有16例（10.8%）需要开放性转换或术后开放性手术修复。最常见的术后并发症为吻合口瘘（6.8%）、伤口相关并发症（4.7%）和会阴疼痛（4.7%）。73例（49.3%）在第7天或更早拔出膀胱导管。至停药的中位时间为1天（平均1.4天，范围1-5天）。口服摄入开始于术后第1天67例（45.2%）和术后第2天65例（43.9%）。结论：虽然腹腔镜根治性直肠癌切除术的技术要求，减少失血量和较短的恢复期可以预期的程序。外科医生应该意识到与早期经验相关的令人不安的高发病率。通过掌握腹腔镜技能和分享知识，外科医生可以减少完成这项手术所需的学习曲线的影响。
Aim: Laparoscopic radical prostatectomy is being evaluated throughout the world. The aim of the present study is to report early multi-institutional experience of the procedure in Japan.Methods: A total of 148 men who were diagnosed with clinically localized prostate cancer underwent laparoscopic radical prostatectomy at seven different institutions in Japan. Early complications (within 30 days postoperatively) and postoperative convalescence were reviewed retrospectively. The median age of patients was 68.0 years (range, 51-80).Results: The median operative time was 403 minutes (range, 167-925; average, 427). Blood loss ranged from 50 to 5000 mL (median, 540; average, 856). A total of 66 complications were reported in 55 patients (37.2%). Intraoperative complications were noted in 25 of 148 patients (16.9%): 10 rectal injuries (6.8%); five bladder injuries (3.4%); five cases of subcutaneous emphysema (3.4%); two intestinal injuries (1.4%); one major vessel injury (0.7%); one ureteral injury (0.7%); and one obturator nerve injury (0.7%). Overall, 16 of 148 patients (10.8%) required open conversion or postoperative open surgical repair. The most common postoperative complications were anastomotic leakage (6.8%), wound-related complications (4.7%) and perineal pain (4.7%). The bladder catheter was removed on day 7 or earlier in 73 cases (49.3%). The median time to ambulation was 1 day (mean 1.4, range 1-5). Oral intake was started on postoperative day 1 in 67 patients (45.2%) and on postoperative day 2 in 65 (43.9%).Conclusion: Although laparoscopic radical prostatectomy is technically demanding, reduced blood loss and shorter convalescence periods can be expected from the procedure. Surgeons should be aware of the disturbingly high morbidity rate related to early experience. By mastering laparoscopic skills and sharing knowledge, surgeons could reduce the impact of the learning curve required to complete this procedure competently.