保留血管神经束的腹腔镜下腹膜外前列腺癌根治术对尿控及性功能影响的手术技巧  

The surgical technique of extraperitoneal laparoscopic radical prostatectomy with nenrovascular bundle preservation and its effect on mictnrition control and sexual function in patients with prostate cancer

作　　者：谭剑敏[1] 徐丹枫[2] 高赟[1] 高轶[2] 周伟民[1] 张涛亮[1] 许嘉骏[1] 朱晓明[1] 付鑫华[1] 

机构地区：[1]上海市闸北区中心医院泌尿外科,200070 [2]第二军医大学附属长征医院泌尿外科

出　　处：《中华老年医学杂志》2009年第7期559-562,共4页Chinese Journal of Geriatrics

摘　　要：目的分析总结保留血管神经束的腹腔镜下腹膜外前列腺癌根治术对尿控及性功能影响的手术技巧。方法对22例前列腺癌患者施行保留血管神经束的腹腔镜下腹膜外前列腺癌根治术，患者年龄61～72岁，中位年龄66．9岁，均有勃起功能，病理证实高级别前列腺上皮内肿瘤（PIN）2例，T1a—b 4例，T1c 9例，T2a—b 4例，T2c 2例，T3a 1例。结果22例手术均成功完成，无1例转开放手术，平均手术时间225min，术中平均出血量850ml，1例由于损伤阴茎背深静脉出现大出血失血量1200ml，输血4例。均于术后2周拔除导尿管，3例患者出现轻度尿失禁，随访6个月后均恢复尿控。未发生术后膀胱尿道吻合口尿漏。1例手术切缘为阳性。术后随访10～24个月，平均16个月，无生化复发。术后性功能恢复者20例。结论保留血管神经束的腹腔镜下腹膜外前列腺癌根治术是一种安全有效的治疗方法，并且有出血少、损伤小、并发症较少的优点，能最大限度保证尿控及性功能，值得临床推广。Objective To analyze the surgical technique of extraperitoneal laparoscopic radical prostatectomy with neurovascular bundle preservation and its effect on micturition control and sexual function in patients with prostate cancer. Methods Twenty-two patients with a median age of 66.9 years underwent extraperitoneal laparoscopic radical prostatectomy with neurovascular bundle preservation from October 2005 to March 2009 in our hospital and Shanghai Changzheng hospital. All patients had no erectile dysfunction. According to the pathology, there were 2 cases of PIN high grade, 4 cases of T1a-b, 9 cases of Tlc, 4 cases of T2a-b, 2 cases of T2c and 1 case of T3a. Results All operation were successful and no case was conversed to open surgery. The average operation time was 225 min and the mean blood loss was 850ml. The amount of blood loss in 1 case was 1200 ml because of injuring deep dorsal vein of penis. 4 cases received blood transfusion, gatheters of all patients were removed 2 weeks after operation, and three cases with mild incontinence regained continence of urine after 6 months follow-up. No patient occurred postoperative vesicourethral anastomotic leakage of urine. The surgical margin of 1 case was positive. No biochemical index of prostatl cancer recurred during postoperative follow-up of 10-24 months （with an average of 16 months）. 20 cases had sexual function recovery after operation. Conclusions The extraperitoneal laparoscopic radical prostatectomy with neurovascular bundle preservation for prostate cancer is a safe and effective treatment method with less bleeding, small damage and less complications. It can guarantee the maximum of mieturition control and sexual function, which is worthy to he popularized in the clinic.

关 键 词：前列腺肿瘤 前列腺切除术 腹腔镜检查 

分 类 号：R686[医药卫生—骨科学]