论文部分内容阅读
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例经腹腔镜施行。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、保护尿道横纹括约肌等措施,保护尿控功能;17例通过保留神经血管束技术(12例保留双侧,5例仅保留一侧)保护性功能。结果手术均成功完成,无围术期严重并发症。2周拔出尿管后,排尿通畅,无尿道狭窄。手术后3、12个月内恢复尿控能力分别为:6例、13例,持续性轻-中度尿失禁2例。21例中,手术前勃起功能正常,并于手术中保留神经血管束17例,手术后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。手术后病理报告均为前列腺腺癌,未侵及精囊.膀胱颈,双侧淋巴结阴性。后尿道切缘阳性1例。手术后6、24、54个月各有1例出现生化复发。结论精细解剖并注意手术技巧,可有效保护性功能和尿控功能,并达到肿瘤根治的疗效。
Objective To investigate the surgical skills and efficacy of urinary control and sexual function protection during radical prostatectomy of the pubis. Methods In August 2001 and January 2010, 21 patients underwent retropubic prostatectomy, of which 2 patients underwent laparoscopy. Early control suture venous complex, and properly handle the tip of the prostate and the urethra. In 21 cases, the function of urinary control was protected by controlling the nerves in the urinary bladder and protecting the sphincter of the urethra. In 17 cases, the neurovascular bundle technique was used in 17 cases (12 cases retained bilateral and 5 cases reserved only one side). Results The operation was successfully completed, no serious complications during the perioperative period. 2 weeks after pulling out the catheter, urination, no urethral stricture. Urine control ability in 3 and 12 months after operation were 6 cases, 13 cases and 2 cases of persistent mild-moderate incontinence. In 21 cases, the preoperative erectile function was normal, and 17 cases of neurovascular bundles were reserved during the operation. The erectile function recovery in 3 and 12 months after operation were 2 and 8 cases, 4 cases of erectile dysfunction and 3 cases of erectile dysfunction . Postoperative pathological reports were prostate adenocarcinoma, no invasion of seminal vesicle, bladder neck, bilateral lymph nodes negative. Posterior urethral margin positive in 1 case. One case of biochemical recurrence occurred 6, 24 and 54 months after operation. Conclusion Fine anatomy and pay attention to surgical skills, which can effectively protect sexual function and urinary control function, and achieve the curative effect of radical tumor.