腹腔镜下保留后尿道及性神经的耻骨后前列腺剜除术

Retropubic enucleation of prostate with preservation of posterior urethra and sexual nerve under laparoscope

目的探讨应用腹腔镜下保留尿道及性功能的耻骨后前列腺剜除术治疗大体积良性前列腺增生症(BPH)患者的临床应用价值。方法收集2015年9月~2019年6月23例大体积良性前列增生症(前列腺体积≥80ml)患者的临床资料,患者平均年龄75岁,前列腺体积为(116.2±10.2)ml。所有患者均实施腹腔镜下保留尿道及性功能的耻骨后前列腺剜除术。记录手术时间、术中出血量、切除前列腺重量、留置盆腔引流管时间、留置尿管时间、平均住院时间;比较术前与术后3月IPSS评分、MFR、男性勃起功能评分的差异、术后勃起功能障碍发生率等。结果所有实施该手术的患者手术均成功,无一例中转开放手术。术中术后评估:手术时间(96±22.8)min,术中出血量(100.4±33.6)ml,切除前列腺质量(92.7±24.5)g,留置盆腔引流管时间(3.2±0.6)d,留置尿管时间(3.6±0.2)d,平均住院时间(6.6±0.2)d。术后3月IPSS评分(5.8±1.7)分,MFR(18.6±2.5)ml/s,术后与术前相比差异有统计学意义(P<0.05);男性勃起功能评分(IIEF-5)(14.2±2.4)分,与术前相比差异无统计学意义(P>0.5)。术后随访3-12月患者男性勃起功能障碍率8.6%(2/23),所有术前勃起功能正常的患者术后勃起功能均存在,1例勃起功能障碍得到改善,所有患者均为顺行射精。结论腹腔镜下保留后尿道及性神经的耻骨后前列腺剜除术是大体积BPH患者有效的治疗方法,值得临床应用推广。

Objective To investigate the clinical value of laparoscopic retropubic prostatectomy with preservation of urethral and sexual function in the treatment of patients with large-volume benign prostatic hyperplasia(BPH).Methods The clinical data of 23 patients with massive benign prostatic hyperplasia(prostate volume≥80 ml)from September 2015 to June2019 were retrospectively analyzed.The average age of the patients was 75 years,and the prostate volume was(16.2±10.2)ml.All patients underwent laparoscopic retropubic prostate enucleation to preserve urethra and sexual function.Meanwhile,their operation time,intraoperative blood loss,weight of the prostate,indwelling pelvic drainage tube time,indwelling urinary tube time,incidence of erectile dysfunction and average hospitalization time were recorded;IPSS score,MFR,and male erectile function score of the patients before and 3 months after surgery were comparatively analyzed.Results All the 23 patients were successfully operated and no conversion open surgery was performed.Intraoperative and postoperative evaluation:the surgical time was(96±22.8)min,the intraoperative blood loss was(100.4±33.6)ml,the weight of the prostate removed was(92.7±24.5)g,and the time for indwelling the pelvic drainage tube was(3.2±0.6)d,indwelling catheter time was(13.6±0.2)d,average hospital stay time was(6.6±0.2)d.After 3 months follow-up,the IPSS score was(5.8±1.7),and the MFR was(18.6±2.5)ml/s.The difference was statistically significant(P<0.05)compared with that before surgery;The male erectile function score(IIEF-5)was 14.2±2.4,which was not significantly different from that before surgery(P>0.5).The rate of male erectile dysfunction was 8.6%(2/23)during the period of 3-12 months follow-up.All patients with normal erectile function had postoperative erectile function.One patient had improved erectile dysfunction and all patients had anterograde ejaculation.Conclusion Laparoscopic retropubic prostatectomy with urethral and sexual function preservation is an effective treatment for patients with large-volume BPH,and it is worthy of application.