【摘要】 目的总结6例经腹腔途径腹腔镜下前列腺癌根治术的临床资料,术中采取后入路隧道式分离盆神经从、神经血管束的新方法,探讨该法对患者术后尿控功能的影响。方法 2015年3月至2016年9月,阳江市阳东区人民医院6例局限性前列腺癌患者术前临床分期均低于T2c期,平均PSA 12.3 ng/ml,均行了筋膜内前列腺癌根治术。在前列腺与直肠间分离出间隙后,提起前列腺及精囊,隧道式分离前列腺两侧盆神经丛、神经血管束间隙,在游离的前列腺与直肠间隙填满纱块;转前入路切开膀胱颈部并切穿后壁,见预填纱块。前列腺两侧神经血管束,前面与背面均形成隧道,与盆腔及直肠间悬吊组织已松解,神经血管束由管状组织变成状,塑料夹钳夹后剪断至前列腺尖部,"八"字型保护好神经血管束。结果患者术中出血量100~600 ml,平均360 ml,术后21 d拔除导尿管。术后住院天数22~30 d,平均26 d。术后病理切缘均阴性,为前列腺内癌变。术后4周平均血清PSA 0.5 ng/ml。随访1~16个月,平均随访7个月。所有患者术后拔尿管1周尿控全部得以恢复,尿垫使用量≤1块/d。结论肿瘤分期较早的患者,后入路结合前入路钝锐性分离盆神经从、神经血管束,孤立组织使团块状变成薄片状组织,保留更多神经及良性筋膜组织,筋膜内切除前列腺可提高患者术后尿控功能。更多还原

【Abstract】 Objective To summarize the experiences and evaluate the urinary continence of a novel tunnel technique via posterior approach for laparoscopic radical prostatectomy with pelvic nerve plexus and neuro vascular bundle being isolated. Methods Six patients admitted to Yang Dong Hospital of Yang Jiang between March 2015 and September 2016 were diagnosed with localized prostate cancer(stage T2c or lower). The mean level of prostate specific antigen(PSA) was 12.3 ng/ml. All patients underwent intrafascial radical prostatectomy. After the prostate was isolated from the rectum, the prostate and seminal vesicle were lifted. The pelvic nerve plexus and neurovascular bundle space were isolated using the tunnel technique. The space between the free prostate and rectum was filled up with gauze. The bladder neck was incised and the posterior wall was penetrated via the anterior approach, and the space was filled up with gauze. A tunnel was created on the frontal and dorsal sides of bilateral neurovascular bundles of the prostate. The suspension tissues between the pelvic cavity and rectum were free. The neurovascular bundle was changed from the tubular shape to layer shape. The apex of the prostate was cut off, and the forcep and the neurovascular bundle was protected. Results Intraoperative hemorrhage volume was 100-600 ml, 360 ml on average. The catheter was removed on the 21 st day postoperatively. Postoperative hospital stay was 22-30 days, 26 days on average. Postoperative pathological examination of the incisional margin yielded negative results, which were diagnosed as prostate cancer. At 4 weeks postoperative, the mean serum level of PSA was 0.5 ng/ml. The duration of follow-up ranged from 1 to 16 months, 7 months on average. For all patients, the urinary continence was restored within 1 week after catheter removal. The daily use of urine diaper was ≤ 1 piece. Conclusion For patients with early tumor staging, posterior approach combined with anterior approach technique can be utilized to isolate the pelvic nerve plexus, neurovascular bundle, change the mass-shape tissues into layered tissues and preserve the nerve and benign fascial tissues as possible. Intrafascial radical prostatectomy can improve postoperative urinary continence.更多还原