摘要
目的:探讨经直肠实时超声引导(TRUS)在保留性神经腹腔镜前列腺癌根治术中(LRP)的作用。方法:2004年6月～2007年3月,对12例TNM分期为T1～T2b的前列腺癌患者行经直肠实时超声引导保留性神经LRP。患者平均年龄62.5岁(57～65岁),术前检查PSA为7.4ng/ml(3.3～9.6ng/ml),IIEF评分平均为17.6分(15～22分)。术中采用TRUS监测神经血管束(NVB)的保留情况。9例保留双侧NVB,3例保留单侧NVB。结果:12例手术均获得成功。平均手术时间分别为270min(210～360min),平均出血量290ml(200～600ml),无切缘阳性患者。9例保留双侧NVB和2例保留单侧NVB的患者均在3～6个月后可成功完成性交。1例保留单侧NVB的患者勃起硬度欠佳,需药物辅助才能完成性交。结论:LRP术中结合TRUS可实时监测NVB的分离,避免NVB的损伤,有助于保留患者阴茎勃起功能。TRUS是保留性神经的LRP术的一种非常实用的新技术。
Objective：To describe the role of real-time transrectal ultrasound （TRUS） intraoperative navigation during nerve-sparing laparoscopic radical prostatectomy （LRP）. Methods：Transperitoneal LRP with TRUS intraoperative guidance and monitoring had been undergone in 12 consecutive cases （TNM T1-T2b） from June 2004 to March 2007. The mean age was 62.5 （57-65 yr） and mean total PSA was 7.4 （3.3-9.6 ng/ml）. All the patients were preoperatively evaluated by self questionnaire of International Index of Erectile Function （IIEF） and mean IIEF score was 17.6 （15-22）. Conventional gray scale and Doppler were placed on identifying and monitoring bilateral NVB, defining the prostate apex contour and evaluating the location and extent of any hypoechoic cancer nodules. Bilateral nerve-sparing LRP was performed in 9 of 12 patients and the other three cases preserved unilateral NVB. Results： All the 12 procedures were successful. Mean operative time was 270 min （range,210- 360 min）. Mean operative blood loss was 290 ml （range,200-600 ml）. Nine men with bilateral NVB preservation and 2 men with one side NVB preservation were able to achieved successful intercourse without any drug assistance 3 to 6 months after the operation, the remaining 1 case had to do it with the aid of sildenafil. Conclusions： This initial experience suggests that real-time intraoperative TRUS guidance and monitoring is an effective means of preserving NVB during LRP and it helps to retain postoperative erectile function of the patients.
出处
《临床泌尿外科杂志》
2008年第3期169-172,共4页
Journal of Clinical Urology
关键词
前列腺癌
腹腔镜术
前列腺切除术
Prostate cancer
Laparoscopy
Radical prostatectomy
