【摘要】 目的  探討在恥骨后前列腺癌根治術中尿控功能和性功能保護的手術技巧和療效。 方法  2001年8月-2010年1月，行恥骨后前列腺癌根治術21例，其中2例經腹腔鏡。所有患者均早期控制縫扎背靜脈復合體，并妥善處理前列腺尖和尿道。21例通過保護控尿神經、尿道橫紋括約肌，保護了尿控功能；17例通過保留神經血管束技術（12例保留雙側，5例保留一側）保護性功能。 結果  手術均成功完成，無圍手術期嚴重并發癥。2周拔出尿管后，排尿通暢，無尿道狹窄。術后3、12個月內恢復尿控能力患者分別為6、13例，持續性輕-中度尿失禁2例。21例患者中，術前勃起功能正常；術中保留神經血管束17例，術后3、12個月內勃起功能恢復分別為2、8例，4例勃起功能減弱，3例不能勃起。術后病理報告均為前列腺癌，未侵及精囊、膀胱頸、雙側淋巴結陰性。后尿道切緣陽性1例。術后6、24、54個月各有1例出現生化復發。 結論  手術精細解剖并注意技巧，可有效保護尿控功能和性功能，并達到腫瘤根治的療效。
【Abstract】 Objective  To evaluate the surgical technique for the protection of urinary continence and erectile function in radical prostatectomy for prostate cancer and observe its clinical efficacy. Methods  Twenty-one patients with prostate cancer had undergone radical prostatectomy during August 2001 to January 2010, in which two patients were operated through extraperitoneal laparoscope. Dorsal vein complex was sewed and ligated at early stage of surgery and prostate apex along with urethra were appropriately handled in all patients. By a serial measures consisting of protection for continence nerve and striated urethral sphincter, the function of urinary continence was managed to be spared in twenty-one patients, erectile function was managed to be spared through reservation of neurovascular bundle in seventeen patients (Bilateral neurovascular bundles were reserved in twelve patients, unilateral neurovascular bundle was reserved in five patients). Results  All surgeries were successful without severe perioperative complications. The catheters were removed fourteen days after surgery in all patients, and it was observed that micturition was fluent in twenty-one patients. Functional recovery of urinary continence occurred within three months after surgery in six patients and twleve months in thirteen patients, continuous mild-moderate incontinece occurred in two patients. Erectile function was normal before surgery and neurovascular bundle was reserved during surgery in seventeen patients. The recovery of erectile function occurred within three months after surgery in two patients and twelve months in eight patients, erectile function was impaired in four patients, erectile dysfunction occurred in three patients, pathological diagnosis indicated prostate adenocarcinoma in all cases, while seminal vesicle and bladder neck were not invaded and bilateral pelvic lymph nodes were not metastasized, moreover, the pathological diagnosis of resected edge of posterior urethra was positive in one patient. One patient of bio-chemical recurrence occurred respectively within six months, twenty-four months and fifty-four months after surgery. Conclusion  During radical prostatectomy for prostate cancer, delicately anatomizing and appropriate surgical technique could effectively protect erectile function and urinary continence and consequently achieve radical resection of tumor at the same time.

引用本文： 余閻宏,肖民輝,張科,楊小華,齊書武,黃杰. 恥骨后前列腺癌根治手術中尿控功能和性功能保護的手術技巧. 華西醫學, 2010, 25(9): 1618-1621. doi: 復制