前列腺癌根治性剜除术的初步探索  

Preliminary exploration of radical enucleation for prostate cancer

作　　者：杨春光 杨俊[1] 李凡[1] 李恒[1] 卢宇超 栾阳 杨帆[1] 王志华 胡志全[1] 王少刚[1] YANG Chunguang;YANG Jun;LI Fan;LI Heng;LU Yuchao;LUAN Yang;YANG Fan;WANG Zhihua;HU Zhiquan;WANG Shaogang(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,武汉430030

出　　处：《临床泌尿外科杂志》2024年第8期664-667,共4页Journal of Clinical Urology

基　　金：湖北省重点研发计划项目(No:2023DJC160)。

摘　　要：目的:探讨前列腺癌根治性剜除术应用于局限期前列腺癌的可行性。方法:收集2023年12月—2024年3月于华中科技大学同济医学院附属同济医院就诊的局限期前列腺癌患者,筛选入组的患者均前列腺特异性抗原(prostate-specific antigen,PSA)<20 ng/mL,且由单一术者完成前列腺癌根治性剜除术。排除临床诊断分期≥T3期、难以耐受全身麻醉手术或拒绝该术式的患者。10例入组患者的中位年龄71岁,中位体重指数25 kg/m^(2),中位Gleason评分3+4=7分。前列腺癌根治性剜除术在Hood技术保护耻骨后和前列腺尖部附近结构的基础上,借鉴后入路根治性前列腺切除术在筋膜内层面探查和前列腺颈部神经血管束保护中的优势,前入路离断膀胱颈主体后迅速自前列腺背侧进入筋膜内层面、逆行松解神经血管束。结果:从切开皮肤至完成皮肤缝合的中位时间为109 min,中位出血量为80 mL;切缘阳性率为20%,术后6周90%的患者PSA<0.2 ng/mL;即刻尿控率达60%;中位随访4个月时勃起功能保留率为86%(6/7)。结论:前列腺癌根治性剜除术在即刻尿控和勃起功能保留方面效果理想,入路和步骤清晰简明,值得临床上参考应用。Objective To investigate the feasibility of radical enucleation of prostate cancer in the application of localized prostate cancer.Methods From December 2023 to March 2024,10 patients with localized prostate cancer with prostate-specific antigen(PSA)<20 ng/mL were screened and enrolled in Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,with a median age of 71 years,a median body mass index of 25 kg/m^(2),and a median Gleason score of 3+4=7.On the basis of Hood technology to protect the structures behind the pubic bone and near the apex of the prostate,radical enucleation of prostate cancer draws on the advantages of posterior radical prostatectomy in the exploration of the intrafascial layer and the protection of the neurovascular bundle in the neck of the prostate.Results The median time from skin incision to skin closure was 109 minutes,and the median blood loss was 80 mL.The positive rate of resection margin was 20%,and PSA<0.2 ng/mL was found in 90%of patients 6 weeks after surgery.Immediate urinary continence rate was 60%,and erectile preservation rates at median follow-up of 4 months were 86%(6/7).Conclusion Radical enucleation of prostate cancer has ideal effect in immediate urinary continence and sexual function preservation,and the approach and steps are clear and concise,which is worthy of clinical reference and application.

关 键 词：局限期前列腺癌 根治性前列腺切除术 筋膜内 剜除术 功能保护 

分 类 号：R737.25[医药卫生—肿瘤]