筋膜内与筋膜间保留神经的腹膜外腹腔镜前列腺癌根治术

Fascia between fascia and nerves reservations extraperitoneal laparoscopic radical prostatectomy

目的将筋膜内与筋膜间保留神经的腹膜外腹腔镜前列腺癌根治术进行对比分析。方法选取2013年1月至2014年11月收治的189例局限性前列腺癌患者为研究对象,且均行筋膜间或筋膜内腹膜外腹腔镜前列腺癌根治术。按照手术方法分为筋膜内组和筋膜间组,筋膜内组63例,筋膜间组126例。随访时间为12个月,对比两组患者的年龄、体质指数(BMI)、血清前列腺特异性抗原(PSA)、Gleason评分、手术时间、术中失血量、切缘阳性率、尿管留置时间及病理分期、术后3、6、12个月两组组间控尿功能、勃起功能。结果两组患者的年龄、BMI、血清PSA、Gleason评分、手术时间、术中失血量、切缘阳性率、尿管留置时间、病理分期、术后12个月组间控尿功能及勃起功能比较,差异无统计学意义(P>0.05);而术后3、6个月筋膜内组控尿功能恢复情况及术后6个月勃起功能恢复情况均好于筋膜间组,差异有统计学意义(P<0.05)。结论对于局限性前列腺癌患者,行筋膜内保留神经的腹膜外腹腔镜前列腺癌根治术,术后控尿和勃起功能恢复情况明显优于筋膜间组,短期临床效果较稳定,但远期的临床效果仍然需要通过延长随访时间和加大样本量来证实。

Objective To analyze and compare the extraperitoneal laparoscopic fascia between reservations and radical prostatectomy nerve. Methods The patients from our hospital between January 2013 and November 2014 were treated. Total 189 cases with localized prostate cancer were included into the present study. All patients underwent fascial fascia extraperitoneal laparoscopic radical prostatectomy. According to surgical methods fascia,these patients were divided into fascia group 63 cases,126 cases among the fascia group. Comparative analysis was performed. Follow- up time was 12 months. The age,BMI,serum PSA,Gleason score,operative time,intraoperative blood loss,positive margin rate,indwelling catheter time and pathological staging,control urinary function,erectile function of two groups patients were compared. Results The age,BMI,serum PSA,Gleason score,surgical time,intraoperative blood loss,positive margin rate,indwelling catheter time,pathological stage,between groups after 12 months of urinary and erectile function of two groups patients did not show the difference,no statistically significant difference（ P〉0. 05）. And after 3 and 6 months,the urinary recovery after 6 months and the recovery of erectile function of two groups had the difference,and the difference was statistically significant（ P〈0. 05）. Conclusion For patients with localized prostate cancer,inline fascia extraperitoneal laparoscopic nerve- sparing radical prostatectomy,postoperative urinary continence and erectile function recovery was significantly better than the fascia group. The short- term clinical results more stable,but far clinical effects still need to extend the period of follow- up time and increase the sample size to be confirmed.