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目的评价腹腔镜下前列腺癌根治术(LRP)中保留神经血管束(NVB)的临床意义。方法2005年8月—2008年3月,对17例局限性前列腺癌患者行LRP,术前临床分期T1b3例,T1c8例,T2b2例,T2c3例,T3a1例。术中采用保护尿道膜部括约肌和双侧前列腺旁神经血管束,重建膀胱颈部充分外翻后,间断、无张力行膀胱颈尿道吻合。结果17例手术均获成功,无一例中转开放。手术平均时间290min(190～370min),出血量平均360ml(200～640ml)。其中2例术中因处理阴茎背血管复合体(DVC)不当出现较大出血,分别为600ml和640ml,均未输血。术后随访6～37个月,全部患者排尿通畅,无肿瘤复发。14例术后6个月内恢复尿控能力,2例在术后9个月内恢复,1例术后12个月后尚存在轻度尿失禁。14例患者在术后12月内可以充分或部分勃起,3例不能勃起。结论LRP中保留双侧NVB,保护尿道膜部括约肌,能有效减少根治术后患者尿失禁及勃起障碍的发生。
Objective To evaluate the clinical significance of preserving neurovascular bundles (NVB) in laparoscopic radical prostatectomy (LRP). Methods From August 2005 to March 2008, 17 patients with localized prostate cancer underwent LRP. There were 3 cases of T1b before operation, 8 cases of T1c, 2 cases of T2b, 3 cases of T2c and 1 case of T3a. Intraoperative use of urethral membrane to protect the sphincter and bilateral paravertebral paraventricular blood vessels, reconstruction of bladder neck full valgus, intermittent, tension-free bladder neck urethra anastomosis. Results All the 17 surgeries were successful, and none of them were switched to open. The average operation time was 290 min (190-370 min) and the average amount of bleeding was 360 ml (200-640 ml). Two cases of intraoperative penile dural vascular complex (DVC) due to improper bleeding, were 600ml and 640ml, were not transfused. All cases were followed up for 6 to 37 months. All patients had voiding and no tumor recurrence. In 14 cases, urinary control ability was recovered within 6 months after surgery, 2 cases recovered within 9 months after operation, and 1 case had mild urinary incontinence after 12 months. Fourteen patients had full or partial erection within 12 months after surgery and three had no erection. Conclusion The preservation of bilateral NVB in the LRP protects the sphincter of the urethra, which can effectively reduce the occurrence of incontinence and erectile dysfunction in patients after radical operation.