腹腔镜下根治性前列腺切除术后勃起功能恢复的影响因素

Analysis of the predicting factors for erectile function recovery after laparoscopic radical prostatecto-my

目的探讨腹腔镜下根治性前列腺切除术（1aparoscopicradicalprostatectomy，LRP）后患者勃起功能（erectilefunction，EF）的恢复情况及影响因素。方法回顾性分析2011年1月至2012年12月收治的106例局限性前列腺癌患者的临床资料。患者手术时年龄49～85岁，平均70岁。体质指数（bodymassindex，BMI）18．4～33．9kg／m2，平均24．8kg／m2。tPSA0．6～167．1μg／L，平均18．4μg／L。术前合并糖尿病13例、高血压病47例、冠心病10例、高脂血症38例。术前吸烟者24例。采用国际勃起功能问卷表．5（internationalindexoferectilefunction-5，IIEF-5）评分评估患者术前EF情况，本组中60例术前存在性生活，IIEF-5评分为9～25分，平均18分。术前26例存在阴茎勃起，但勃起硬度不足以完成性生活，20例阴茎无法勃起。本组LRP均由同一术者完成。术后EF恢复定义为术后存在阴茎勃起。随访患者术后EF的恢复情况，分析患者年龄、合并症、术前EF状态及手术方式等因素对术后EF恢复的影响。结果本组106例术后随访8～31个月，平均18个月。60例术前存在性生活者与总体106例在年龄、合并症、手术相关参数及术后病理结果等因素方面比较差异无统计学意义（P〉0．05）。LRP术后EF恢复率为46．7％（28／60），术后所有患者均未采用辅助勃起的药物或器械。手术时年龄≤60岁者EF恢复率为90．0％（9／10），明显优于61～70岁组的53．8％（14／26）和〉70岁组的20．8％（5／24），差异均有统计学意义（P=0．001）。术前IIEF-5评分22～25分者EF恢复率为66．7％（8／12），优于评分〈22分者（P=0．006）。术中保留神经血管束和副阴部内动脉者的EF恢复率分别为53．1％（26／49）和83．3％（5／6），均优于未保留者（P=0．036和P=0．023）。结论LRP术后EF的恢复与多种因素相关，患者手术时年龄和术前EF的情况显著影响LRP术后EF的恢复，保留神经血管束和副阴部内动脉对术后EF的恢复也有帮助。

Objective To evaluate the recovery rate of erectile function （EF） and identify various factors predicting the recovery of EF in men undergoing laparoscopic radical prostatectomy （LRP） in our center. Methods From January 2011 to December 2012, a total of 106 men with localized prostate cancer underwent LRP in our center by one surgeon were included, and we gathered the preoperative EF condition and perioperative factors, such as patients＇ age, comorbidity and surgical procedure, et al. We followed up all the patients by telephone in August 2013 to collect the EF recovery data of these patients after LRP, with the mean follow-up of 18 （8-31） months. We analyzed the perioperative factors in order to predict the EF recovery after LRP. Results A total of 60 patients with preoperative sexual activity were included, and there was no difference in baseline data compared with other cases. Recovery of potency was defined as post- operative penile erection. The recovery rate of EF was 46.7% （28/60） without the use of any drugs or de- vices for erection assistance. In our study, the recovery rate of EF in age ≤60 years was 90.0% （9/10） ,and it was better than other two older groups （ P = 0.001 ）. In patients whose preoperative IIEF-5 score was 22-25, the recovery rate of EF was 66.7% （8/12）, and it was better than those with IIEF-5〈 22 （P = 0.006）. The recovery rate of EF in patients with preserved neurovascular bundle was 53.1% （26/49） and it was 83.3% （5/6） in patients with preserved accessory pudendal artery, which was better than those without preservation （P = 0.036 and P = 0.023）. Conclusions In our study, age and preoperative EF were the significant factors to predict potency recovery, and preservation of neurovascular bundle and accessory pu- dendal artery during LRP were the positive predictor factors.