改良血管阻断技术在腹腔镜筋膜内根治性前列腺切除术的应用  

Application of a modified vascular blocking technique in intrafascial nerve-sparing laparoscopic radical prostatectomy

作　　者：邵四海[1] 沈悦凡[1] 向安平[1] 沈旭峰 SHAO Si-hai;SHEN Yue-fan;XIANG An-ping;SHEN Xu-feng(Department of Urology,Huzhou First People's Hospital,Huzhou,Zhejiang 313000,China)

机构地区：[1]湖州市第一人民医院泌尿外科,浙江湖州313000

出　　处：《中华男科学杂志》2023年第1期38-42,共5页National Journal of Andrology

摘　　要：目的:探讨改良血管阻断技术在腹腔镜保留性神经筋膜内根治性前列腺切除术的临床疗效。方法:回顾性分析2021年7月至2022年8月收治的13例应用改良血管阻断技术开展腹腔镜保留性神经筋膜内根治性前列腺切除术的患者临床资料。年龄64~73(68.8±3.15)岁,13例均为常规体检提示前列腺特异性抗原(PSA)升高,术前PSA 4.71~16.12(9.71±3.50)μg/L。13例均经会阴在超声引导下行前列腺穿刺活检确诊为前列腺癌。穿刺活检组织Gleason评分6分7例,7分6例。术前磁共振检查均未发现肿瘤突破前列腺包膜及盆腔淋巴结转移。运用改良分束浅表缝扎背深静脉复合体(DVC)联合前列腺外侧蒂血管阻断技术行腹腔镜下保留性神经筋膜内根治性前列腺切除术。结果:1例术中一侧包膜破裂,快速冰冻提示切缘阳性,故该侧改筋膜外切除,术后病理检查13例均未发现切缘阳性。8例术后即刻恢复尿控,5例拔除尿管术后2周内恢复。术后1个月起开始使用小剂量他达拉非片(5 mg qd),术后1、3个月勃起功能恢复IIEF-5评分>15分分别为31%(4/13)和62%(8/13)。结论:采用改良血管阻断技术行腹腔镜筋膜内根治性前列腺切除术,术中出血控制及术后肿瘤控制良好,尿控功能及男性勃起功能恢复较满意。本研究样本量少,随访时间尚短,缺乏对照,有待进一步临床研究验证。Objective:To investigate the clinical effect of a modified vascular blocking technique in intrafascial nerve-sparing laparoscopic radical prostatectomy(INLRP).Methods:We retrospectively studied the clinical data on 13 cases of INLRP completed via a modified vascular blocking technique between July 2021 and August 2022.The patients ranged in age from 64 to 73(68.8±3.15)years,with elevated PSA of 4.71-16.12(9.71±3.50)μg/L preoperatively.Prostate cancer was confirmed in all the cases by ultrasound-guided perineal prostate needle biopsy,with Gleason 6 in 7 cases and Gleason 7 in 6 cases.MRI revealed no preoperative tumor breakthrough in the prostatic capsule or pelvic lymph node metastasis.All the patients received INLRP with a modified superficial suture dorsal vein complex(DVC)combined with lateral prostatic pedicle vascular blocking.Results:Prostatic capsule rupture occurred in 1 case during the operation,with positive resection margin indicated by rapid intraoperative frozen biopsy,so the lateral fascia resection was modified.No positive resection margin was found in any of the cases in postoperative pathological examinations.Urinary continence was restored in 8 cases immediately after surgery and in the other 5 within 2 weeks after catheter removal.At 1 month after surgery,all the patients were medicated with low-dose tadalafil(5 mg qd),and IIEF-5 scores of>15 were achieved in 4 cases(31%)at 1 month and in another 8(62%)at 3 months postoperatively.Conclusion:INLRP via modified vascular blocking showed the advantages of desirable intraoperative bleeding control and postoperative tumor control,restoration of urinary continence and relatively satisfactory recovery of erectile function.However,due to the small sample size,short follow-up time and lack of control,our findings need to be further verified by more clinical studies.

关 键 词：前列腺肿瘤 前列腺癌 根治性手术 前列腺筋膜 控尿 勃起功能 

分 类 号：R737.25[医药卫生—肿瘤]