会陰式前立腺全摘術200例の手術合併症に関する検討

Abstract

In recent years, robot-assisted laparoscopic prostatectomy has become widely used, and the perineal approach is utilized much less than before. However, radical perineal prostatectomy has some advantages with regard to operative complications. Here I evaluate 200 cases for which the perineal approach was used in the past 12 years. From 2000 to 2012, radical perineal prostatectomies were performed for 200 patients and their operative complications were evaluated. The mean age of the patients was 68.5 years, with a PSA of 9.4 ng/ml, and Gleason score of 6.9. Their clinical stages were T1 in 168 cases (84.0%), T2 in 26 (13.0%) and T3 in 6 (3.0%). Mean operative time was 85 minutes, and estimated blood loss was 220.0 ml. The median time for urethral catheter indwelling was 7 days, and the admission term was 14 days. Operations were performed safely in patients with a BMI of more than 30 kg/m2. Lymphadenectomies from the same incision were performed in 20 cases and there were no lymph node metastases. Rectal injuries occurred in 7 cases (3.5%) with 100 cases of Blet's approach so I changed to Young's approach. With Young's approach I have not experienced any rectal injuries. Wound infection occurred in 4 cases (2.0%), hematoma in 2 (1.0%), anastomotic stricture in 1 (0.5%), inguinal hernia in 1 (0.5%), and transient lower extremity neurapraxia in 1 (0.5%). Postperineal pain after operation was tolerated using a donut cushion, though some pain relievers were needed in 20 cases (10.0%). Fecal incontinence occurred in 4 cases (2.0%) but was temporary. With radical perineal prostatectomy it is easy to perform vesicourethral anastomosis, apical dissection and nerve sparing, and there are few complications such as inguinal hernia, anastomotic stricture and so on. In addition, there is less blood loss with this approach because the dorsal vein complex and pudendal arteries are out of sight. Therefore, radical perineal prostatectomy is suggested to be useful because of its safety, short operation time and low cost. Finally this procedure can be selected as the first choice for patients with past history of lower abdominal operation and obesity.