根治性膀胱切除术后勃起功能障碍病因及防治的研究进展

Research progress in etiology,prevention and treatment of erectile dysfunction after radical cystectomy

随着人口的老龄化,我国膀胱癌发病率逐年增加。根治性膀胱切除术(RC)作为局部膀胱癌治疗的标准方案之一,术后极易出现勃起功能障碍(ED),严重降低了患者术后的生活质量。随着基础医学不断对勃起相关的解剖生理机制进行深入研究发现,患者术前一般情况、术中神经损伤以及围手术期心理障碍等因素是导致术后ED的原因。因此,对于实行RC且对性功能有需求的患者,可于术中保留前列腺周围神经血管束相关组织,并在围手术期间进行心理治疗。同时,对于术后性功能不佳的患者,可通过药物治疗、物理干预、阴茎假体植入手术、中医中药等手段改善患者的勃起功能,提高其性生活满意度。

With the aging of population,the incidence of bladder cancer in China is increasing year by year.As one of the standard options for treatment of localized bladder cancer,radical cystectomy(RC)is highly prone to postoperative erectile dysfunction(ED),which seriously reduces patients'quality of life.Following the continuous in-depth study of erection-related anatomical and physiological mechanisms in basic medicine,it has been found that many factors are responsible for postoperative ED,such as the patient's general preoperative condition,intraoperative nerve injury,and perioperative psychological disorders.Therefore,for patients who are suitable for RC and strong desire for sexual function,the tissue associated with the periprostatic neurovascular bundle can be preserved intraoperatively and psychological treatment should be provided during the perioperative period.Meanwhile,for patients with poor postoperative sexual function,drug,physical intervention,penile prosthesis implantation,and Chinese herbal medicine can be used to enhance the patient's erectile function and thus improve sexual life satisfaction.