保留神经血管束的耻骨后前列腺癌根治术的疗效观察

Radical prostatectomy: experience of shanghai punan hospital

目的:小结开展保留神经血管束的耻骨后前列腺癌根治术(RRP)的经验和教训。方法:对40例穿刺活检证实的前列腺癌患者行RRP,术前采用新辅助治疗,术中采用保护尿道膜部括约肌和前列腺侧旁神经血管束,并在重建膀胱颈部粘膜充分外翻后的后壁行折叠缝合1针。间断、无张力行残留尿道和外翻的膀胱颈缝合。结果:经3～78个月随访,全部患者排尿通畅,无肿瘤复发;除2例发生轻度尿失禁外,余38例在6个月内均恢复尿控能力。结论:充分做好耻骨后前列腺癌根治术前的准备工作,有利于手术操作;术中保护好尿道膜部括约肌和前列腺侧旁神经血管束,在充分外翻膀胱粘膜的重建膀胱颈后壁折叠缝合,能减少前列腺癌根治术后尿失禁的发生。

Objective：To report the results of prostate cancer patients treated with neoadjuvant androgen deprivation therapy and radical retropubic prostatectomy （RRP）. Methods：A total of 40 patients were diagnosed as having prostate cancer by biopsy. Neoadjuvant androgen deprivation therapy was scheduled to prescribe before radical prostatectomy. The membranous part of sphincter urethrae and the neurovascular bundle （NVB）lateral to the prostate were preserved. We evaginated the posterior wall of the bladder adequately and make an additional folding stitch to rebuild the bladder neck. Results：With a median follow up 3-78 months, no tumor recurrence and dysuria were found, Only 2 cases occurred slight incontinence. Other 38 cases regained continence of urine within 6 months postoperatively. Conclusions：Ultrasound guided transrectal biopsy and Color Doppler Image （CDI） would enhance the cancer detection rate significantly. The neoadjuvant androgen deprivation therapy reduced the volume of prostate and the level of PSA , facilitating the operation. The incontinence of urine after RRP could be reduced by the method of preserving the membranous part of sphincter urethra and the NVB lateral to the prostate during operation. It could also be avoided by evaginate the posterior wall of the bladder adequately and make an additional folding stitch to the bladder neck.