| Forewords:Prostate cancer has become the highest incidence of male malignancies in the United States and Europe,and in recent years there has been a sustained increase in the incidence of prostate cancer in our country.Due to the incidence of prostate cancer is unclear,and most of the patients with nonspecific symptoms early,it is easy to result in misdiagnosis and missed diagnosis,delay the best treatment time,cause many patients with prostate cancer have been found,for local or distant metastasis.In recent years as people increasingly attention to their body health and prostate cancer screening method is popularized and medical conditions continue to improve,and for prostate cancer diagnosis technology is also continuously improving,home of the diagnosis of early prostate cancer is significantly higher.in better economic conditions in some areas,we can found and treat it early,to a large extent also reduces the patient’s family and social burden.Currently,the treatment of prostate cancer is becoming more and more varied,and radical prostatectomy is considered to be the best option for the treatment of localized prostate cancer.The operation is mainly through the following ways:open prostate cancer,prostate cancer radical laparoscopic radical prostatectomy,robot assisted laparoscopic radical prostatectomy prostate cancer.The preferred method for treating localized prostate cancer in China is still a laparoscopic radical prostatectomy(LRP).Laparoscopic radical prostatectomy prostate cancer since 1992 to carry out,is now gradually gradually popularized throughout the world,after years of development and perfection,with the upgrading of laparoscopic display system,laparoscopic radical prostatectomy prostate cancer has been gradually realized the standardization and normalization.LRP small surgical trauma,surgical field amplification can clearly express the tissues and organs and anatomical structure,separation,suture operation,intraoperative and postoperative complications can be reduced,to speed up the recovery and so on,can achieve similar to open surgery.Although traditional laparoscopic technology advantage obviously,but he limited by two dimensional vision,can not accurately reflect the surgical field of open surgery,causing performer of the surgical area information for missing.And conventional laparoscopic performer lack of depth perception of feedback,make a surgeon at the time of operation laparoscopic instruments can’t,like open surgery,flexible,and make the most accurate judgment,increasing the difficulty of beginners,which greatly limits the development of laparoscopic technique.Even a surgeon with an open experience can take a long time to understand the depth of the surgery field.Above these faults is not conducive to performer in the operation,so the traditional laparoscopic radical prostatectomy prostate cancer did not significantly reduce postoperative complications,especially the probability of the occurrence of postoperative incontinence is still high,according to the statistics after the eradicative resection of the prostate cancer patients have a 4%-70%of patients suffer from urinary incontinence in a year after surgery.Now the people for the treatment of prostate cancer is no longer a simple request prostate cancer effect a radical cure,recovery of postoperative urinary control function,sexual function is becoming more and more attention.Patients’ quality of postoperative life demand is higher and higher,this causes to explore a new mode of operation,we continue to innovation to develop new surgical equipment to meet the needs of the patient.In the 1990s,the three-dimensional display system was a laparoscopic system that made laparoscopic operations safer and faster.The 3D laparoscopic hd system improves doctors’ perception of the depth of the laparoscopic procedure,which is impossible under normal 2D laparoscopy.In 2 d laparoscopic surgery,the depth and level of awareness of the lack of organs and tissues is one of the biggest hurdles that surgeons,laparoscopic hd and 3 d systems in reducing the real three-dimensional surgical field and the most accurate spatial positioning at the same time,the depth of the maximum provides anatomical and three-dimensional level,to improve the precision of the complicated complex operation,reduce the operation risk,is advantageous for the performer for deep operation.In prostate cancer radical,can clearly distinguish structure layers of tissues and organs,and can realize accurate separation and fine stitching,3 d laparoscopic these advantages in reducing the incidence of patients with complications after radical prostatectomy aspects should be reflected,is worth us to explore further.Objective:Prostate cancer(Pca)is one of the most common malignant tumors of the urinary system.Conventional two-dimensional(2-Dimentional)laparoscopic technique has undergone radical resection of Pca.In recent years,with 3D(3-Dimentional)technology improvement and application of its radical prostatectomy in the application of the advantages are gradually reflected,especially in patients with early urine control recovery.To Compare the postoperative recovery of continence after 3D and 2D laparoscopic radical prostatectomy.In this paper,the clinical data of patients undergoing 3D laparoscopic and 2D laparoscopic radical prostatectomy were used to compare the effects of 3D laparoscopy and 2D laparoscopy on the recovery of urinary bladder after radical prostatectomy,and To explore the advantages of 3D laparoscopic radical prostatectomy.Methods:A retrospective analysis of 72 patients underwent radical prostatectomy in our department from January 2013 to December 2015,including 38 cases underwent 3D laparoscopic radical prostatectomy,3D group’s mean age was(64.24±6.00)years,mean of preoperative PSA was(14.52±7.59)ug/L,Gleason score(13 cases≤6,17 cases=7,8 cases>8),the mean prostate volume(41.39 + 9.10)ml,the classification of clinical stage in 3D group included 2 cases in cT1,26 cases in cT2,9 cases in cT3a,1 cases in cT3b,mean body mass index was(22.78 + 2.17)kg/m2,mean of MUL(membranous urethral length)was(15.62 + 2.57)mm;34 cases in the 2D group,3D group’s mean age was(61.88±6.63)years,mean of preoperative PSA was(16.73±6.79)ug/L,Gleason score(10 cases≤6,18 cases=7,6 cases>8),the mean prostate volume(42.09±10.62)ml,the classification of clinical stage in 3D group included 1 cases in cT1,28 cases in cT2,5 cases in cT3a,mean body mass index was(21.67±1.90)kg/m2,mean of MUL(membranous urethral length)was(15.51±2.51)mm.All patients with a good function of micturition and urinary continence.We compared the two groups’ surgical time,bladder neck-urethral anastomosis time,blood loss,Membranous urethral length(MUL)were measured on preoperative and postoperative magnetic resonance imaging(MRI),the MUL loss caused by surgery(ie,preoperative MUL-postoperative MUL),blood transfusion rate,postoperative urinary leakage rate,positive margin rate,postoperative continence rate after the catheter removed for 2 weeks,4 weeks,8 weeks,12 weeks and 24 weeks,36 weeks.Results:All the operations were completed successfully by the same surgeon and none was transferred to open surgery.Two groups in age,PSA value,Gleason score,prostate volume,TNM stage,BMI(body mass index)and other relevant aspects of the clinical data showed no significant difference(P>0.05).The time of bladder neck-urethral anastomosis is less than the 2D group[(12.89 ± 1.71)min and(15.69± 2.62)min,P = 0.021],3 D laparoscopic surgery caused the MUL loss is less than 2D laparoscopic[(0.513 ± 0.125)ml and(0.582 ± 0.160)ml,P = 0.044],the two groups in operative time[(162.68 ± 17.12)min and(175.74 ± 15.74)min,P = 0.802],intraoperative blood loss[(191.08 ± 31.60)ml and(211.79 ± 43.16)ml,P = 0.021],intraoperative blood transfusion rate[5.2%(2/38)and 8.8%(3/34),P = 0.662],postoperative incidence of urine leakage[7.9%(3/38)and 14.7%(5/34),P = 0.463],preoperative MUL[(15.623 + 2.570)mm and(15.511 + 2.506)ml,P = 0.852),postoperative the MUL[(15.110 + 2.571)mm and(14.929 2.581)mm,P =0.767),there was no statistically significant differen,The incisal margin was pathologically negative in both groups.All patients were followed up for urinary function at least 36 months,the two group’s continence rate at 8 weeks(60.5%compared to 35.3%)、12 weeks(73.7%over 47.1%)were significantly different after catheter removed,the rest of the time there was no statistically significant difference.The two groups were statistically significant in the comparison of the function recovery curve after the removal of the catheter.ICI-Q-SF rating scale to assess the subjective feelings of patients,the results showed that the two groups of patients with urinary incontinence from January after surgery from the difference,to postoperative 2 months,3 months there are still significant differences,and then gradually shrink after the beginning of June there is no significant difference,after two months of subjective feelings are basically the same.We used ICI-Q-SF rating scale to assess the subjective feelings of patients,the results showed that two groups of patients with urinary incontinence from 1 month after surgery from the difference,to 2 months,3 months there are still significant differences,and then gradually reduced,6 months after the start of no significant difference,after 12 months the subjective feelings of the two are basically the same.Conclusions:3D laparoscopic radical prostatectomy can reduce the difficulty of operation,improve the accuracy of surgery,help identify the organizational structure of the hierarchy,you can accurately identify the special position of the bladder neck,the tip of the urethra,and thus more conducive to the protection of patients membranous urethra length,and help patients early recovery of urinary continence function,help to improve patients with early symptoms of urinary incontinence;It is easier to perform deep precision operation in 3d high resolution stereoscopic view,which can shorten the anastomosis time of the bladder. |
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