耻骨后前列腺癌根治术中尿控功能和性功能保护的手术技巧  

Surgical Technique for the Protection of Urinary Continence and Erectile Function in Radical Prostatectomy for Prostate Cancer

作　　者：余阎宏[1] 肖民辉[1] 张科[1] 杨小华[1] 齐书武[1] 黄杰[1] 

机构地区：[1]云南省第一人民医院泌尿外科,昆明650021

出　　处：《华西医学》2010年第6期1071-1074,共4页West China Medical Journal

摘　　要：目的探讨在耻骨后前列腺癌根治术中尿控功能和性功能保护的手术技巧和疗效。方法 2001年8月2010年1月,行耻骨后前列腺癌根治术21例,其中2例经腹腔镜施行。均早期控制缝扎背静脉复合体,并妥善处理前列腺尖和尿道。21例通过保护控尿神经、保护尿道横纹括约肌等措施,保护尿控功能;17例通过保留神经血管束技术(12例保留双侧,5例仅保留一侧)保护性功能。结果手术均成功完成,无围术期严重并发症。2周拔出尿管后,排尿通畅,无尿道狭窄。手术后3、12个月内恢复尿控能力分别为:6例、13例,持续性轻-中度尿失禁2例。21例中,手术前勃起功能正常,并于手术中保留神经血管束17例,手术后3、12个月内勃起功能恢复分别为:2、8例,4例勃起功能减弱,3例不能勃起。手术后病理报告均为前列腺腺癌,未侵及精囊.膀胱颈,双侧淋巴结阴性。后尿道切缘阳性1例。手术后6、24、54个月各有1例出现生化复发。结论精细解剖并注意手术技巧,可有效保护性功能和尿控功能,并达到肿瘤根治的疗效。Objective To evaluate the surgical technique for the protection of urinary continence and erectile function in radical prostatectomy for prostate cancer and observe its clinical efficacy. Methods Atotal of 21 cases of patients with prostate cancer had been undergone radical prostatectomy during August of 2001 to January of 2010,in which two cases were operated through extraperitoneal laparoscope. Dorsal vein complex was sewed and ligated at early stage of surgery and prostate apex along with urethra were appropriately handled in all cases. By a serial measures consisting of protection for continence nerve and striated urethral sphincter,the function of urinary continence was managed to be spared in 21 cases,erectile function was managed to be spared through reservation of neurovascular bundle in 17 cases（Bilateral neurovascular bundles were reserved in 12 cases,unilateral neurovascular bundle was reserved in five cases）. Results All surgeries were successful without severe perioperative complications. The catheters were removed at the 14th day after surgery in all cases,it was observed that micturition was fluent in 21 cases. Functional recovery of urinary continence occurred within three months after surgery in 6 cases and 12 months in 13 cases,continuous mild-moderate incontinece occurred in two cases. Erectile function was normal before surgery and neurovascular bundle was reserved during surgery in 17 cases. The recovery of erectile function occurred within three months after surgery in two cases and 12 months in 8 cases,erectile function was impaired in 4 cases,erectile dysfunction occurred in three cases,pathological diagnosis indicated prostate adenocarcinoma in all cases,while seminal vesicle and bladder neck were not invaded and bilateral pelvic lymph nodes were not metastasized,moreover,the pathological diagnosis of resected edge of posterior urethra was positive in one case. One case of bio-chemical recurrence occurred respectively within 6 months,24 months and 54 months after surgery. Conclusion D

关 键 词：前列腺癌 耻骨后前列腺癌根治术 性功能 尿控功能 

分 类 号：R737.25[医药卫生—肿瘤]