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目的:总结近10年来100例耻骨后根治性前列腺切除术的经验和教训。方法:1999年7月至2009年7月笔者行耻骨后根治性前列腺切除术100例,对其中84例随访3~120个月,统计术前年龄、PSA,术中输血量、手术时间,术后尿控能力、阴茎勃起功能,吻合口狭窄情况和最大尿流率。结果:患者平均年龄、PSA、输血量及手术时间分别为66.8岁、20.1 ng/ml、585.7 ml和198.9 min。术后3、6、12个月尿控分别为65.5%、81.7%和92.4%,术后12个月有42.2%恢复阴茎勃起功能,吻合口狭窄5例,最大尿流率平均20.5 ml/s,生化复发13例,死于前列腺癌1例。结论:耻骨后根治性前列腺切除术治疗局限性前列腺癌效果好,采用先结扎耻骨前列腺韧带和前列腺静脉丛后再离断耻骨前列腺韧带的方法有利于提高尿控能力,要得到术后好的阴茎勃起效果,应注意保护神经血管束和副阴部动脉,良好的尿道粘膜和膀胱粘膜对合可减少吻合口狭窄,对T3a或伴局部淋巴结转移患者术后外放疗可减缓生化复发。
Objective: To summarize the experience and lessons of 100 cases of radical retropubic prostatectomy in the past 10 years. Methods: From July 1999 to July 2009, 100 cases of radical retrobulbar prostatectomy were performed in 84 cases, followed up for 3 to 120 months. The data of preoperative age, PSA, intraoperative blood transfusion, operation time and operation Post-diastolic function, penile erection, anastomotic stenosis and maximal uroflow rate. Results: The mean age, PSA, blood transfusion, and operative time were 66.8 years, 20.1 ng / ml, 585.7 ml, and 198.9 min, respectively. Urine control at 3, 6 and 12 months after operation was 65.5%, 81.7% and 92.4% respectively. After 12 months, 42.2% recovered penile erection, 5 cases had anastomotic stenosis and the maximal uroflow rate was 20.5 ml / s , Biochemical recurrence in 13 cases, 1 case of prostate cancer. Conclusion: The treatment of local prostatectomy after radical retropubic prostatectomy is effective. The method of ligating the pubic prostate ligament and the prostate plexus before disconnecting the pubod Prostate ligaments is helpful to improve the urinary control ability. To obtain a good postoperative penis Erectile effects should be noted to protect the neurovascular bundle and the paranasal artery, good urinary tract mucosa and bladder mucosa on the joint can reduce anastomotic stenosis, postoperative radiotherapy for patients with T3a or with lymph node metastasis can slow the biochemical recurrence.