【摘要】 目的 探讨局限性前列腺癌(PCa)患者采用改良经腹膜外腹腔镜全筋膜内根治性前列腺切除术(RP)对其勃起功能、尿流动力学的改善效果。方法 回顾性选取浙江中医药大学附属第一医院庆元分院2020年1月至2022年6月收治的局限性PCa患者82例，依据术中筋膜处理方式的不同分为对照组(41例)和观察组(41例)。两组均行经腹膜外腹腔镜RP,对照组术中给予常规筋膜间保留血管神经束，观察组术中给予改良全筋膜内切除。比较两组手术相关指标、勃起功能、尿流动力学指标、疼痛状况及并发症。结果 两组手术时间、出血量、引流管留置时间、住院时间、切缘阳性占比比较，差异均无统计学意义(P>0.05)。术后6个月两组国际勃起功能指数-5(IIEF-5)评分相比术前均升高；观察组术后6个月IIEF-5评分及勃起功能恢复率高于对照组，视觉模拟评分法(VAS)评分低于对照组，差异具有统计学意义(P<0.05)。两组术后6个月最大膀胱容量(MBC)、最大尿道闭合压(MUCP)比术前升高，观察组高于对照组；术后6个月充盈期膀胱顺应性值(BC)、残余尿量(PVR)、逼尿肌不稳定率(DI)比术前降低，观察组低于对照组，差异均具有统计学意义(P<0.05)。观察组术后6个月随访的总并发症发生率低于对照组，差异具有统计学意义(P<0.05)。结论 改良经腹膜外腹腔镜全筋膜内RP应用于局限性PCa患者可促进勃起功能恢复，减轻疼痛症状，调节尿流动力学指标水平，安全性良好。更多还原

【Abstract】 Objective To investigate the improvement effects of modified peritoneal laparoscopic whole-fascial radical prostatectomy(RP) on erectile function and urodynamics in patients with localized prostate cancer(PCa). Methods A total of 82 patients with localized PCa admitted to Qingyuan Branch of the First Affiliated Hospital of Zhejiang Chinese Medical University from January 2020 to June 2022 were retrospectively selected, and divided into the control group(41 cases) and the observation group(41 cases) according to different intraoperative fascia treatment methods. Both groups received RP by peritoneal laparoscopy, the control group received routine interfascial vaso-nerve bundle preservation during the operation, and the observation group received modified total intrafascial excision during the operation. The surgery-related parameters, erectile function, urodynamics, pain status and complications were compared between the two groups. Results There were no significant differences in operation time, bleeding volume, drainage tube indwelling time, hospital stay and proportion of positive margin between the two groups(P>0.05). The scores of international index of erectile function-5(IIEF-5) of the two groups after operation were all higher than those before operation at 6 months. The score of IIEF-5 and erectile function recovery rate of the observation group at 6 months after operation were higher than those of the control group, and the score of visual analogue scale(VAS) was lower than that of the control group, the differences were statistically significant(P<0.05). The maximum bladder capacity(MBC) and maximum urethral closure pressure(MUCP) of the two groups at 6 months after operation were higher than those before operation, and the observation group was higher than the control group. Bladder compliance value(BC), postvoid residual volume(PVR) and detrusor instability rate(DI) at 6 months after operation were lower than those before operation, and the observation group was lower than the control group, the differences were statistically significant(P<0.05). The incidence of total complications in the observation group was lower than that in the control group at 6 months after operation, and the difference was statistically significant(P<0.05). Conclusions The application of modified peritoneal laparoscopic whole-fascial RP in patients with localized PCa can promote the recovery of erectile function, reduce pain symptoms, regulate the level of urodynamics, with good safety.更多还原