摘要
目的评估腹腔镜根治性膀胱切除与回肠原位新膀胱术中采用保留神经技术,对于患者远期勃起和尿控功能的影响。方法收集2015年5月至2018年10月行腹腔镜根治性膀胱切除与回肠原位新膀胱术的男性膀胱癌患者47例,所有患者术中均行双侧标准盆腔淋巴结清扫。根据术中是否保留尿控和勃起神经,分为保留神经组24例和非保留神经组23例。所有患者术后4周完成膀胱造影,无异常后拔除导尿管,每3个月定期复查,术后12个月行尿流动力学检查与国际勃起功能指数调查问卷-5(IIEF-5),收集所有患者的临床资料和完整随访信息。结果所有患者均顺利完成手术。保留神经组和非保留神经组患者平均年龄分别为(60.9±8.3)岁和(61.4±9.9)岁,两组患者平均手术时间分别为(289.5±68.8)min和(329.0±42.6)min(P<0.05)。两组患者术中估计失血量、术中输血率、术后90天内并发症发生率均无统计学意义。保留神经组和非保留神经组患者手术前IIEF-5评分无统计学意义,手术12个月时,两组患者IIEF-5评分分别为(12.3±7.2)分和(6.6±4.8)分(P<0.01)。保留神经组有13例(54.2%)患者能维持性生活,其中7例(29.2%)患者需要依靠西地那非,而非保留神经组仅有5例(21.7%)患者能维持性生活,且均需要依靠西地那非(P<0.05)。保留神经组和非保留神经组患者的术后残余尿量分别为(22.5±28.6)ml和(49.6±41.7)ml(P<0.05),两组患者的最大尿流率分别为(18.3±2.4)ml/s和(16.2±2.2)ml/s(P<0.01)。两组患者的日间控尿率分别为87.5%和69.9%,而夜间控尿率分别为70.8%和43.5%(P=0.058)。结论腹腔镜根治性膀胱切除回肠原位新膀胱术中采取保留神经的操作,对于患者远期的勃起和尿控功能均有帮助,并且不会显著延长患者手术时间和影响肿瘤控制效果,值得临床推广应用。
Objective To evaluate the long-term functional outcomes of the laparoscopic nerve sparing radical cystectomy and ileal orthotopic neobladder for the treatment of muscle invasive bladder cancer.Methods Forty-seven male patients with bladder cancer who underwent orthotopic neobladder reconstruction after laparoscopic radical cystectomy at our institution and were followed up for at least 12 months after surgery were included in this retrospective study.In this series,standard bilateral pelvic lymphadenectomies were performed in all patients.According to whether the erectile nerve was reserved,the patients were divided into two groups,the nerve sparing group and the non-preservation nerve group.All patients completed cystography at 4 weeks after operation,and catheter can be removed smoothly.Regular follow-up was carried out every three months.In addition,continent status and erectile function in each patient were evaluated using urodynamic examination and International Index of Erectile Function 5(IIEF-5)questionnaire 12 months postopteraively.Clinical data and complete follow-up information of all patients were collected.Results All operations were successful.The mean age of the patients in the nerve sparing group and the non-preservation nerve group were(60.9±8.3)years and(61.4±9.9)years,respectively.The operation time of the two groups were(289.5±68.8)minutes and(329.0±42.6)minutes,respectively(P<0.05).However,there was no significant difference in the estimated blood loss,intraoperative blood transfusion rate or the incidence of postoperative complications in 90 days between the two groups.And there was no significant difference in preoperative IIEF-5 score between the nerve sparing group and the non-preservation nerve group.However,12 months later,the IIEF-5 score of the two groups were(12.3±7.2)and(6.6±4.8)(P<0.01),respectively.Among them,13 patients(54.2%)in the nerve sparing group were able to maintain sexual life,of which 7 patients(29.2%)were dependent on sildenafil,while only 5 patients(21.7%)in th
作者
张涛
于德新
方露
闵捷
毕良宽
马嘉兴
耿浩
张涛涛
吴旺宇
ZHANG Tao;YU Dexin;FANG Lu;MIN Jie;BI Liangkuan;MA Jiaxing;GENG Hao;ZHANG Taotao;WU Wangyu(Department of Urology,Second Hospital of Anhui Medical University, Hefei 230601, China)
出处
《现代泌尿生殖肿瘤杂志》
2020年第2期81-85,共5页
Journal of Contemporary Urologic and Reproductive Oncology
基金
安徽省高校自然科学研究重点项目(KJ2018A0209)。
关键词
根治性膀胱切除
原位新膀胱
勃起
尿控
神经血管束
Radical cystectomy
Orthotopic neobladder
Erection
Continence
Neurovascular bundle
