摘要
目的探讨改良的保留神经根治性前列腺癌切除术的临床疗效。方法30例前列腺癌患者采用改良根治性保留神经的前列腺切除术。改良的关键点：采用注水分离前列腺周围筋膜的方法，将Veil保留神经技术应用于开放手术中（即改良Veil保留神经技术）；扩大分区（9区5组）盆腔淋巴结清扫；完整保留膀胱颈；集束捆扎背深静脉复合体；跳针套叠技术行膀胱与尿道的吻合。术后行控尿及勃起功能国际问卷-5（IIEF-5）随访。结果患者平均年龄62岁，前列腺特异性抗原（PSA）水平平均11．9ng／ml，手术时间平均150min（75-240min），术中出血量平均350ml（100—1600m1），术前IIEF-5评分平均为21分，病理分期pT18例、pT2a 15例、pT2b4例、pT3a3例。Gleason评分5分2例、6分7例、7分20例、8分1例。手术切缘阳性4例，其中2例为T2期，占T2期的10．5％（2／19），2例为T3期。无围手术期严重并发症。平均随访19个月（6～48个月），术后1个月完全控尿27例（90％），3个月达100％。术后3个月和6个月IIEF-5评分分别为13、19分，分别恢复到术前水平的40％和70％。结论对选择性的前列腺癌患者，改良的保留神经根治性前列腺切除术较完整保留了前列腺周围所有的筋膜神经，使术后控尿及性功能得到早期、快速恢复，切缘阳性发生率低，疗效可靠。
Objective To evaluate the clinical value of the modified nerve-sparing open antegrade retropubic radical prostatectomy （MNS-ORP）. Methods MNS-ORPs were performed in 30 patients with clinically localized prostate cancer. The modified technique included： endopelvic fascia was not incised, the prostate capsule was freed laterally from surrounding fasciae and dorsally; using the method of separating the peripheral fascia of the prostate, the Veil technique was applied to the open operation, that is, the modified Veil perserving nerve technology; pelvic lymph node dissections （9 regions and 5 groups） were extended; bladder neck preservation was completed; deep dorsal vein complex was bunched; jumper intussusception technology was applied for bladder and urethral anastomosis. Functional outcomes of continence and sexual function （IIEF-score） were followed-up. Results Median age of patients was 62 years old, and the level of PSA was 11.9 ng/ml. Median operating time was 150 minutes （75-240 minutes）, blood loss was 350 ml （100- 1 600 ml）, preoperative IIEF-score was 21 scores （15-25 scores）. Pathologic stage included pT1 （8 cases）, pT2a （15 cases）, pT2b （4 cases） and pT3a （3 cases）. By Gleason score, there were 2 cases of 5 scores, 7 cases of 6 scores, 20 cases of 7 scores and 1 case of 8 scores. 4 cases had positive margins including 2 cases （10.5 %） of pT2 and 2 cases （67 %） of pT3. There were no postoperative complications. Mean follow-up was 19 months （6-48 months）. At the 1st month, 27 patients （90 %） got full continence, and at the 3rd month, all of the patients had full continence. At the 3rd month and the 6th month, median IIEF-scores were 13 and 19 scores, respectively with baseline of IIEF-score reaching by 40 % （at the 3rd month） and 70 % （at the 6th month） of preoperative level. Conclusions MNS-ORP follows rationales of radical prostatectomy and might be considered for selected patients. Preserving all periprostatic fasciae/nerves can recover e
出处
《肿瘤研究与临床》
CAS
2015年第10期680-682,686,共4页
Cancer Research and Clinic
关键词
前列腺肿瘤
前列腺切除术
保留神经
控尿
性功能
Prostate neoplasms
Prostatectomy
Nerve sparing
Urinary continence
Sexual function
