耻骨后前列腺癌根治手术中尿控功能和性功能保护的手术技巧

Surgical Technique for the Protection of Urinary Continence and Erectile Function in Radical Prostatectomy for Prostate Cancer

目的探讨在耻骨后前列腺癌根治术中尿控功能和性功能保护的手术技巧和疗效。方法 2001年8月2010年1月,行耻骨后前列腺癌根治术21例,其中2例经腹腔镜。所有患者均早期控制缝扎背静脉复合体,并妥善处理前列腺尖和尿道。21例通过保护控尿神经、尿道横纹括约肌,保护了尿控功能;17例通过保留神经血管束技术(12例保留双侧,5例保留一侧)保护性功能。结果手术均成功完成,无围手术期严重并发症。2周拔出尿管后,排尿通畅,无尿道狭窄。术后3、12个月内恢复尿控能力患者分别为6、13例,持续性轻-中度尿失禁2例。21例患者中,术前勃起功能正常;术中保留神经血管束17例,术后3、12个月内勃起功能恢复分别为2、8例,4例勃起功能减弱,3例不能勃起。术后病理报告均为前列腺癌,未侵及精囊、膀胱颈、双侧淋巴结阴性。后尿道切缘阳性1例。术后6、24、54个月各有1例出现生化复发。结论手术精细解剖并注意技巧,可有效保护尿控功能和性功能,并达到肿瘤根治的疗效。

Objective To evaluate the surgical technique for the protection of urinary continence and erectile function in radical prostatectomy for prostate cancer and observe its clinical efficacy.Methods Twenty-one patients with prostate cancer had undergone radical prostatectomy during August 2001to January 2010,in which two patients were operated through extraperitoneal laparoscope.Dorsal vein complex was sewed and ligated at early stage of surger-y and prostate apex along with urethra were appropriately handled in all patients.By a serial measures consisting of protection for continence nerve and striated urethral sphincter,the function of urinary continence was managed to be spared in twenty-one patients,erectile function was managed to be spared through reservation of neurovascular bundle in seventeen patients（Bilateral neurovascular bundles were reserved in twelve patients,unilateral neurovascular bundle was reserved in five patients）.Results All surgeries were successful without severe perioperative complications.The catheters were removed fourteen days after surgery in all patients,and it was observed that micturition was fluent in twenty-one patients.Functional recovery of urinary continence occurred within three months after surgery in six patients and twleve months in thirteen patients,continuous mild-moderate incontinece occurred in two patients.Erectile function was normal before surgery and neurovascular bundle was reserved during surgery in seventeen patients.The recovery of erectile function occurred within three months after surgery in two patients and twelve months in eight patients,erectile function was impaired in four patients,erectile dysfunction occurred in three patients,pathological diagnosis indicated prostate adenocarcinoma in all cases,while seminal vesicle and bladder neck were not invaded and bilateral pelvic lymph nodes were not metastasized,moreover,the pathological diagnosis of resected edge of posterior urethra was positive in one patient.One patient of bio-chemical recurrence occurred respectively within six months,twenty-four months and fifty-four months after surgery.Conclusion During radical prostatectomy for prostate cancer,delicately anatomizing and appropriate surgical technique could effectively protect erectile function and urinary continence and consequently achieve radical resection of tumor at the same time.