目的

总结经腹膜外途径腹腔镜根治性前列腺切除术并发直肠损伤的处理经验。

方法

回顾分析2014 年1 月至2022 年10 月绍兴市人民医院行经腹膜外途径腹腔镜下根治性前列腺切除术并发直肠损伤的5 例患者的临床资料。1 例前行经尿道前列腺切除术病理发现前列腺癌，4 例经会阴前列腺穿刺活检术证实前列腺癌，手术时间在穿刺后1～2 周。3 例术中发现直肠损伤，均予以一期直肠修补，其中2 例因直肠破口较大且肠道准备差、术野污染严重行预防性结肠造口术，1 例仅行直肠修补术未行预防性结肠造口术。2 例术后发现直肠损伤，1 例行保守治疗成功，另1 例行结肠造口术，4 个月后行经肛直肠尿道瘘修补术，再3 个月后行结肠回纳术。

结果

5 例患者均获得良好愈合，无粪尿，无伤口感染、盆腔脓肿、脓毒血症、腹膜炎等发生，术后2 周膀胱尿道造影无造影剂外溢。

结论

经腹膜外途径腹腔镜下根治性前列腺切除术直肠损伤好发于尖部，术中及时发现直肠损伤并行腹腔镜下一期直肠修补术及其重要，术前良好的肠道准备为一期直肠修补创造良好机会，且无需预防性结肠造口术。

Objective

To summarize the management experience of radical prostatectomy complicated with rectal injury by extraperitoneal laparoscopic approach.

Methods

A retrospective analysis was made of the clinical data of 5 patients who underwent radical prostatectomy complicated with rectal injury through extraperitoneal laparoscopic approach in Shaoxing People's Hospital from January 2014 to October 2022.One patient was pathologically found to have prostate cancer after transurethral prostatectomy，and the other 4 patients were confirmed to have prostate cancer by perineal prostatectomy.The operation time was 1-2 weeks after the puncture.In 3 cases，rectal injury was found directly during the operation and primary rectal repair was performed，of which 2 cases，prophylactic colostomy was performed due to large rectal laceration，poor intestinal preparation and serious contamination of the operating field and 1 case only underwent rectal repair without prophylactic colostomy.Rectal injury was found in the 2 cases after operation，one underwent conservative treatment successfully，the other underwent colostomy，transanal rectourethral fistula repair 4 months later，and coloplasty 3 months later.

Results

All the 5 patients had good healing，no fecal urine，wound infection，pelvic abscess，sepsis，peritonitis，etc.Cystourethrography showed no contrast extravasation.

Conclusions

The rectal injury in radical prostatectomy by extrasperitoneal laparoscopy is most likely to occur in the apical part.The timely detection of rectal injury during the operation and the subsequent laparoscopic primary rectal repair are extremely important.Good preoperative intestinal preparation creates a good opportunity for primary rectal repair，without the need for preventive colostomy.