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

【】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。？【Abstract】ObjectiveToevaluatethesurgicaltechniquefortheprotectionofurinarycontinenceanderectilefunctioninradicalprostatectomyforprostatecancerandobserveitsclinicalefficacy.MethodsTwenty-onepatientswithprostatecancerhadundergoneradicalprostatectomyduringAugust2001toJanuary2010,inwhichtwopatientswereoperatedthroughextraperitoneallaparoscope.Dorsalveincomplexwassewedandligatedatearlystageofsurgeryandprostateapexalongwithurethrawereappropriatelyhandledinallpatients.Byaserialmeasuresconsistingofprotectionforcontinencenerveandstriatedurethralsphincter,thefunctionofurinarycontinencewasmanagedtobesparedintwenty-onepatients,erectilefunctionwasmanagedtobesparedthroughreservationofneurovascularbundleinseventeenpatients(Bilateralneurovascularbundleswerereservedintwelvepatients,unilateralneurovascularbundlewasreservedinfivepatients).ResultsAllsurgeriesweresuccessfulwithoutsevereperioperativecomplications.Thecatheterswereremovedfourteendaysaftersurgeryinallpatients,anditwasobservedthatmicturitionwasfluentintwenty-onepatients.Functionalrecoveryofurinarycontinenceoccurredwithinthreemonthsaftersurgeryinsixpatientsandtwlevemonthsinthirteenpatients,continuousmild-moderateincontineceoccurredintwopatients.Erectilefunctionwasnormalbeforesurgeryandneurovascularbundlewasreservedduringsurgeryinseventeenpatients.Therecoveryoferectilefunctionoccurredwithinthreemonthsaftersurgeryintwopatientsandtwelvemonthsineightpatients,erectilefunctionwasimpairedinfourpatients,erectiledysfunctionoccurredinthreepatients,pathologicaldiagnosisindicatedprostateadenocarcinomainallcases,whileseminalvesicleandbladderneckwerenotinvadedandbilateralpelviclymphnodeswerenotmetastasized,moreover,thepathologicaldiagnosisofresectededgeofposteriorurethrawaspositiveinonepatient.Onepatientofbio-chemicalrecurrenceoccurredrespectivelywithinsixmonths,twenty-fourmonthsandfifty-fourmonthsaftersurgery.ConclusionDuringradicalprostatectomyforprostatecancer,delicatelyanatomizingandappropriatesurgicaltechniquecouldeffectivelyprotecterectilefunctionandurinarycontinenceandconsequentlyachieveradicalresectionoftumoratthesametime.