前列腺癌根治术132例临床分析

Clinical analysis of radical retropubic prostatectomy:a report of 132 cases

目的总结行前列腺癌根治术的经验和教训,对手术疗效和影响患者生活质量的因素进行分析。方法1993年1月至2005年3月共开展前列腺癌根治手术132例,按照手术的时间,将患者分为早期组(2000年前,34例)和近期组(2001年后,98例),分别统计围手术期各指标情况,对近期组中63例患者的随访结果进行分析;对78例患者的阴茎勃起功能状况进行跟踪调查,其中19例行阴茎夜间生物电阻抗体积测定(NEVA)检查。结果近期组和早期组相比,与手术技术相关的指标逐渐优化。随访的病例中无死于前列腺癌者;以血清前列腺特异抗原(PSA)>0.4μg/L为标准,有9例生化复发。50例在术后6个月内恢复正常排尿,压力性尿失禁8例,完全性尿失禁5例。4例出现膀胱颈部尿道狭窄。56例保留双侧神经患者中,33例(58.9%)恢复勃起功能;22例保留单侧神经患者中,7例(31.8%)恢复勃起功能;19例行NEVA检查者中,动脉供血不足者14例,4例恢复勃起功能;静脉漏者5例,均未恢复勃起功能。结论前列腺癌根治术治疗局限性前列腺癌效果较好。熟悉前列腺解剖,保护血管神经束以及良好的手术技巧,是手术成功的关键,也是影响患者术后生活质量的重要因素。

Objective To summarize the experience of radical retropubic prostatectomy（RRP） and the multi-factors which influence on the prognosis and long life quality. Methods From January 1993 to March 2005, 132 cases radical retropubic prostatectomy were proformed. The patients were divided into 2 groups： the early group and recent group. Eleven items in peri-operative time and follow up results were statisticed. The erection function of 78 cases were investigated with international index of erectile function 5 score. In these patients, nocturnal electrobioimpedance volumetric assessment（NEVA） were observe in 19 cases. Results Comparing of the 2 groups, the index connected with operative skill changed to optimization. No one died of prostate cancer in 63 follow up patients. Nine cases showed biochemical failure with criterion as prostate specific antigen 〉 0. 4μg/L . Fifty patients passed urine normal post-operation in 6 months. Eight patients had stress incontience and 5 had entire incontinence at 6 month. Four patients had vesical neck stricture. Another follow up result shows 33 （58.9%） erection function recovered in 55 bilateral nerve-sparing operation and 7 recovered in 22 of unilateral nerve-sparing operation. NEVA showes 14 cases with artery supply insufficient in whom 4 regained erection function and 5 cases vein leakage in whom no one recovered. Conclusions The radical retropubic prostatectomy remains the procedure of choice for the cure of localized prostatic cancer. The keys for the operation are anatomic dissection, preservation of the neurovascular bundle and good skill. These are also important for a good life quality for the patients.