水刀在根治性前列腺切除术中保留勃起神经的应用初探  

Application of water-jet dissection in nerve-sparing laparoscopic radical prostatectomy:a single center experience

作　　者：李凡[1] 宋晓东[1] 刘卓[1] 胡嘏 陈忠[1] 杨为民[1] 王少刚[1] 叶章群[1] LI Fan;SONG Xiaodong;LIU Zhuo;HU Jia;CHEN Zhong;YANG Weimin;WANG Shaogang;YE Zhangqun(Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China)

机构地区：[1]华中科技大学同济医学院附属同济医院泌尿外科

出　　处：《现代泌尿生殖肿瘤杂志》2019年第4期205-208,215,共5页Journal of Contemporary Urologic and Reproductive Oncology

摘　　要：目的探讨水刀在根治性前列腺切除术中保留勃起神经的可行性及安全性。方法回顾性分析我院2014年至2018年期间收治的前列腺癌并接受根治性前列腺切除术患者的临床资料,从中筛选出采用经腹膜外腹腔镜根治性前列腺切除术并在术中使用水刀进行组织分离、保留神经血管束的患者8例作为水刀手术组;选取采用同种手术方式,但未采用水刀操作的患者10例作为标准手术组。分析上述患者的临床病理资料及围手术期资料。对比两组患者的术前PSA水平、临床TNM分期、前列腺体积、术中出血量、围手术期并发症和手术时间,以及手术前后国际勃起功能评分-5(IIEF-5)变化和术后尿控能力方面的差异。结果水刀手术组患者的年龄小于标准手术组患者(57岁vs 69岁,P=0.011),两者之间存在统计学差异。两组患者的术前PSA水平、术前cTNM分期、前列腺体积和术后pTNM分期等指标差异无统计学意义。水刀手术组患者在术中出血量(500ml vs 700ml,P=0.016)和手术前后IIEF-5变化值(1 vs 3,P=0.027)等指标上优于标准手术组,但两者在围手术期并发症的发生率(25% vs 40%,P=0.638)、手术时间(130min vs 140min,P=0.687)和术后尿垫使用数量(1 vs 1,P=0.094)等方面差异无统计学意义。结论腹腔镜根治性前列腺切除术中使用水刀分离神经血管束能有效保护患者的勃起功能,减少术中出血量,同时不明显增加手术时间和围手术期并发症的发生率。Objective To investigate the feasibility and safety of water-jet in nerve-sparing during radical prostatectomy. Methods The clinical data from patients with prostate cancer who underwent radical prostatectomy between 2014 and 2018 were retrospectively analyzed. Eight patients who underwent laparoscopic radical prostatectomy and applied the water-jet for neurovascular bundles preserving and nerve-sparing were selected as the water-jet group. Ten patients who underwent the same surgical procedure but did not apply water-jet were selected as the standard surgical group. The clinical and pathological data and perioperative data of the above patients were analyzed. The preoperative PSA level, clinical TNM stage, prostate volume, intraoperative blood loss, perioperative complications and operative time, as well as changes in IIEF-5 scores and postoperative urinary control were compared between the two groups. Results The age of patients in the water-jet group was significantly younger than that in the standard surgery group (57 years vs. 69 years, P =0.011). There was no statistical difference in preoperative PSA levels, preoperative cTNM staging, prostate volume, or postoperative pTNM staging. Patients in the water-jet group had less intraoperative blood loss (500 ml vs. 700 ml, P =0.016) and smaller decrease in IIEF-5 scores before and after surgery (1 vs. 3, P =0.027). However, there was no statistical difference in the incidence of perioperative complications (25% vs. 40%, P =0.638), operative time (130 min vs. 140 min, P =0.687) or the number of postoperative pads used (1 vs. 1, P =0.094). Conclusions The use of water-jet to modulate the neurovascular bundle during laparoscopic radical prostatectomy can effectively preserve the patient's erectile function and reduce the intraoperative blood loss, but not increase the incidence of perioperative complications.

关 键 词：前列腺癌 根治性前列腺切除术 水刀 神经保留 

分 类 号：R737.25[医药卫生—肿瘤]