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目的探讨保留前列腺包膜的膀胱根治性切除-原位回肠新膀胱术的手术方法及疗效。方法2002年5月至2008年9月,对35例浸润性膀胱癌患者施行了保留前列腺包膜的膀胱根治性切除-原位回肠新膀胱术,其中开放手术22例,腹腔镜手术13例。术中保留患者的前列腺包膜、精囊、输精管、神经血管束。术后对患者进行定期随访,了解患者的生活质量、排尿情况,并检测患者的残余尿量、新膀胱压力及性功能情况等。结果全部患者均顺利完成保留前列腺包膜和勃起神经的膀胱根治性切除-原位回肠新膀胱术。其中开放手术时间为210～330 min,平均271 min;术中出血200～800 ml,平均460 ml。腹腔镜手术时间为210～420 min,平均343 min;术中出血80～800 ml,平均377 ml。术后3个月IVU及代膀胱造影检查,显示双肾显影良好,无输尿管返流及梗阻,代膀胱充盈良好,容量约250～350 ml。术后6个月随访,所有患者均能自行排尿,2例患者有夜间尿失禁。术后71.4%(20/28)的患者保留了阴茎勃起功能。无患者出现尿道残端或前列腺包膜肿瘤复发,有2例发生盆腔淋巴结转移,1例骨转移。结论保留前列腺包膜的膀胱根治性切除术与标准的膀胱前列腺根治性切除术相比,具有操作简单、控尿效果好、可保留勃起神经等特点,适用于对性功能要求较强、肿瘤未累及膀胱颈及前列腺的较年轻的患者。然而,其肿瘤控制效果还有待于进一步观察。
Objective To investigate the curative effect and curative effect of radical nephroureterectomy with preserved prostate capsule. Methods From May 2002 to September 2008, 35 patients with invasive bladder cancer underwent radical cystectomy-prostatic ileal neo-bladder surgery, including 22 open surgery and 13 laparoscopic surgery. Intraoperative preservation of the patient’s prostate capsule, seminal vesicles, vas deferens, neurovascular bundle. Regular follow-up of patients after surgery to understand the patient’s quality of life, urination, and to detect residual urine volume of patients, the new bladder pressure and sexual function and so on. Results All the patients successfully completed the radical cystectomy for preserving the capsule and erectile nerve of the prostate - in-situ ileal neo-bladder surgery. The open operation time was 210 ~ 330 min, an average of 271 min; intraoperative bleeding 200 ~ 800 ml, an average of 460 ml. Laparoscopic surgery time was 210 ~ 420 min, an average of 343 min; intraoperative bleeding 80 ~ 800 ml, an average of 377 ml. Three months after operation IVU and on behalf of cystography, showed good development of both kidneys without ureteral reflux and obstruction, on behalf of the bladder filling well, the capacity of about 250 ~ 350 ml. Six months after the operation, all patients were able to urinate on their own, and two patients had nighttime incontinence. Postoperative 71.4% (20/28) of patients retained penile erection. No urethral stump or prostate cancer recurrence occurred in 2 cases of pelvic lymph node metastasis and 1 case of bone metastasis. Conclusions The radical cystectomy with preserved prostate capsule has the advantages of simple operation, good urine control effect and reserved erectile nerve compared with the standard radical prostatectomy. It is suitable for the patients who require strong sexual function, Bladder neck and prostate involving the younger patients. However, its tumor control effect remains to be further observed.