筋膜内与筋膜间保留神经的腹腔镜前列腺癌根治术后的功能恢复情况比较

摘要

ABSTRACT:Objective To compare the function recovery after bilateral intrafascial versus interfascial nerve‐sparing tech‐niques in extraperitoneal laparoscopic radical prostatectomy for prostate cancer .Methods A total of 180 cases of prostate cancer were divided into 2 groups:patients with localized prostate cancer (PCa) undergoing bilateral intrafascial nerve‐sparing extraperitoneal laparoscopic radical prostatectomy (intrafascial group , n=60) ,and patients with localized PCa receiving bilat‐eral interfascial nerve‐sparing extraperitoneal laparoscopic radical prostatectomy (interfascial group , n= 120 ) .Results There were no differences in age ,BMI ,serum PSA ,operation time ,intraoperative bleeding volume ,catheter indwelling time and pathological staging between the two groups (P>0 .05) .Three months after operation ,there was difference in urinary continence between the two groups (P<0 .05) .Six months after operation ,there were differences in urinary continence and e‐rectile function between the intrafascia group (45% ) and interfascia group (28 .3% ) (P<0 .05) .Twelve months after opera‐tion ,the erectile function of intrafascia group (61 .7% ) and interfascia group (47 .5% ) were statistically different (P<0 .05) . The positive rate of cutting edge in the intrafascia group (18 .3% ) was higher than that in the interfascia group (15 .8% ) ,with statistical difference (P<0 .05) .Conclusion In case of confirmed diagnosis without operation contraindications ,interfascial nerve‐sparing extraperitoneal laparoscopic radical prostatectomy produces better results of urinary continence and erectile func‐tion recovery .%目的：比较筋膜内与筋膜间保留神经的腹腔镜前列腺癌根治术后的功能恢复情况。方法纳入前列腺癌患者180例，按照2∶1的比例进行配对研究，分为进行筋膜间组和筋膜内组。筋膜间组采用筋膜间保留神经的腹腔镜前列腺癌根治术；筋膜内组采用筋膜内保留神经的腹腔镜前列腺癌根治术。结果两组在年龄、BMI、血清PSA、手术时间、术中出血量、尿管留置时间及病理分期比较，差异均无统计学意义（P＞0．05）。术后3月两组间控尿功能比较，差异有统计学意义（P＜0．05）。术后6月两组间控尿功能、勃起功能（筋膜内组45．0％vs．筋膜间组28．3％）比较，差异均有统计学意义（P＜0．05）。术后12月两组间勃起功能（筋膜内组61．7％vs．筋膜间47．5％）比较，差异有统计学意义（P＜0．05）。筋膜内组切缘阳性率（18．3％）高于筋膜间组（15.8％），差异有统计学意义（P＜0．05）。结论在术前诊断明确，无明显手术禁忌证的前提下，筋膜内组术后控尿和勃起功能恢复优于筋膜间组，对于临床中行LRP的患者，我们建议采用筋膜内保留神经的腹腔镜前列腺癌根治术。