The aim of this study was to validate the advantages of the intrafascial nerve-sparing technique compared with the interfascial nerve-sparing technique in extraperitoneal laparoscopic radical prostatectomy. From March...The aim of this study was to validate the advantages of the intrafascial nerve-sparing technique compared with the interfascial nerve-sparing technique in extraperitoneal laparoscopic radical prostatectomy. From March 2010 to August 2011, 65 patients with localized prostate cancer （PCa） underwent bilateral intrafascial nerve-sparing extraperitoneal laparoscopic radical prostatectomy. These patients were matched in a 1.2 ratio to 130 patients with localized PCa who had undergone bilateral interfascial nerve-sparing extraperitoneal laparoscopic radical prostatectomy between January 2008 and August 2011. Operative data and oncological and functional results of both groups were compared. There was no difference in operative data, pathological stages and overall rates of positive surgical margins between the groups. There were 9 and 13 patients lost to follow-up in the intrafascial group and interfascial group, respectively. The intrafascial technique provided earlier recovery of continence at both 3 and 6 months than the interfascial technique. Equal results in terms of continence were found in both groups at 12 months. Better rates of potency at 6 months and 12 months were found in younger patients （age 65 years） and overall patients who had undergone the intrafascial nerve-sparing extraperitoneal laparoscopic radical prostatectomy. Biochemical progression-free survival rates I year postoperatively were similar in both groups. Using strict indications, compared with the interfascial nerve-sparing technique, the intrafascial technique provided similar operative outcomes and short-term oncological results, quicker recovery of continence and better potency. The intrafascial nerve-sparing technique is recommended as a preferred approach for young PCa patients who are clinical stages cT1 to cT2a and have normal preoperative potency.展开更多
目的探讨基于多模式麻醉方式的加速康复外科(ERAS)理念在腹腔镜膀胱癌根治术中的价值。方法收集2015年1月至2017年12月我院行腹腔镜下膀胱癌根治术和/或回肠代膀胱术的患者围术期相关信息,应用基于多模式麻醉方式的ERAS理念进行围术期...目的探讨基于多模式麻醉方式的加速康复外科(ERAS)理念在腹腔镜膀胱癌根治术中的价值。方法收集2015年1月至2017年12月我院行腹腔镜下膀胱癌根治术和/或回肠代膀胱术的患者围术期相关信息,应用基于多模式麻醉方式的ERAS理念进行围术期处理的为ERAS组(9例),应用常规围术期处理方案的为常规治疗组(27例)。比较两组患者的住院时间、术后疼痛等差异。结果 ERAS组患者较常规治疗组总住院时间及术后住院时间均明显减少(20 d vs 33 d,P=0.002;9 d vs 18 d,P=0.002),术中补液量明显降低[5.5(ml/kg/h) vs 8.1(ml/kg/h),P=0.003],术后按时予镇痛药的患者比例更高(P=0.001),临时需要再次追加镇痛药的比例更低(P=0.046),术后首次排便时间更快(P=0.035)。而在住院总花费、麻醉费用和术后并发症方面,两组差异无统计学意义。结论在腹腔镜膀胱癌根治术应用多模式麻醉方式联合ERAS理念,可以加快患者的康复速度,减少术后对追加镇痛药的需要,对术后并发症无影响。展开更多
文摘The aim of this study was to validate the advantages of the intrafascial nerve-sparing technique compared with the interfascial nerve-sparing technique in extraperitoneal laparoscopic radical prostatectomy. From March 2010 to August 2011, 65 patients with localized prostate cancer （PCa） underwent bilateral intrafascial nerve-sparing extraperitoneal laparoscopic radical prostatectomy. These patients were matched in a 1.2 ratio to 130 patients with localized PCa who had undergone bilateral interfascial nerve-sparing extraperitoneal laparoscopic radical prostatectomy between January 2008 and August 2011. Operative data and oncological and functional results of both groups were compared. There was no difference in operative data, pathological stages and overall rates of positive surgical margins between the groups. There were 9 and 13 patients lost to follow-up in the intrafascial group and interfascial group, respectively. The intrafascial technique provided earlier recovery of continence at both 3 and 6 months than the interfascial technique. Equal results in terms of continence were found in both groups at 12 months. Better rates of potency at 6 months and 12 months were found in younger patients （age 65 years） and overall patients who had undergone the intrafascial nerve-sparing extraperitoneal laparoscopic radical prostatectomy. Biochemical progression-free survival rates I year postoperatively were similar in both groups. Using strict indications, compared with the interfascial nerve-sparing technique, the intrafascial technique provided similar operative outcomes and short-term oncological results, quicker recovery of continence and better potency. The intrafascial nerve-sparing technique is recommended as a preferred approach for young PCa patients who are clinical stages cT1 to cT2a and have normal preoperative potency.
文摘目的探讨基于多模式麻醉方式的加速康复外科(ERAS)理念在腹腔镜膀胱癌根治术中的价值。方法收集2015年1月至2017年12月我院行腹腔镜下膀胱癌根治术和/或回肠代膀胱术的患者围术期相关信息,应用基于多模式麻醉方式的ERAS理念进行围术期处理的为ERAS组(9例),应用常规围术期处理方案的为常规治疗组(27例)。比较两组患者的住院时间、术后疼痛等差异。结果 ERAS组患者较常规治疗组总住院时间及术后住院时间均明显减少(20 d vs 33 d,P=0.002;9 d vs 18 d,P=0.002),术中补液量明显降低[5.5(ml/kg/h) vs 8.1(ml/kg/h),P=0.003],术后按时予镇痛药的患者比例更高(P=0.001),临时需要再次追加镇痛药的比例更低(P=0.046),术后首次排便时间更快(P=0.035)。而在住院总花费、麻醉费用和术后并发症方面,两组差异无统计学意义。结论在腹腔镜膀胱癌根治术应用多模式麻醉方式联合ERAS理念,可以加快患者的康复速度,减少术后对追加镇痛药的需要,对术后并发症无影响。
