免缝扎背深静脉复合体技术在30例筋膜内保留神经腹腔镜根治性前列腺切除术中的应用
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摘要
目的探讨双侧筋膜内腹腔镜前列腺癌根治术(INLRP)中免缝扎背深静脉复合体(DVC)的手术技巧和临床疗效。方法回顾性分析我院2015年1月至2018年06月30例双侧筋膜内腹腔镜前列腺癌根治术的患者资料,术中免缝扎DVC,统计手术时间、术中出血量、围术期输血率、手术切缘阳性率、术后生化复发、术后尿失禁(拔除尿管后即刻、1个月、3个月、6个月)及术后6个月性功能等数据。结果 30例患者均在腹腔镜下顺利完成手术。手术时间(123.57±53.63)min,术中出血量(225.00±300.77)mL,手术切缘阳性率3/30(10.0%),输血率2/30(6.67%)。平均留置尿管11(8～15)d。拔除导尿管后即刻、1个月、3个月、6个月尿垫使用≤1块/d的患者占比分别为13.33%、53.33%、83.33%、96.67%。25例术前有性生活的患者术后6个月能勃起完成性交17例(68.0%)。随访期间术后6个月出现2例生化复发(6.67%)。结论双侧筋膜内腹腔镜前列腺癌根治术中免缝扎DVC安全有效,有利于术后控尿功能及性功能的早期恢复。
Objective To explore the techniques and clinical outcomes of ligation-free for deep vein complex(DVC)in bilateral intrafascial nerve-sparing laparoscopic radical prostatectomy(INLRP).Methods The clinical data of 30 patients who underwent INLRP during Jan.2015 and June 2018 were retrospectively analyzed.DVC was not ligated during the operation.The operation time,intraoperative blood loss,perioperative blood transfusion rate,positive surgical margin rate,biochemical recurrence and urinary incontinence were recorded(immediately after catheter removal,1 month,3 and6 months postoperatively).Potency was recorded6 months postoperatively.Results All operations were successful.The operation time,estimated blood loss,positive surgical margin rate and transfusion rate was(123.57±53.63)minutes,(225.00±300.77)mL,3/30(10.0%),and 2/30(6.67%),respectively.The average catheter indwelling time was 11(range,8～15)d.Postoperative in continence immediately after Foley catheter removal,and 1 month,3 and 6 months after surgery was 13.33%,53.33%,83.33%and 96.67%,respectively.Of the 25 preoperatively sexually active patients,17(68.0%)were able to erect adequately and perform sexual intercourse 6 months after operation.Biochemical relapse occurred in 2 cases(6.67%)during the follow-up.Conclusion Ligation-free technique for DVC is safe and effective in bilateral intrafascial nerve-sparing laparoscopic radical prostatectomy,which is conducive to the early recovery of continence and sexual function.
Objective To explore the techniques and clinical outcomes of ligation-free for deep vein complex(DVC)in bilateral intrafascial nerve-sparing laparoscopic radical prostatectomy(INLRP).Methods The clinical data of 30 patients who underwent INLRP during Jan.2015 and June 2018 were retrospectively analyzed.DVC was not ligated during the operation.The operation time,intraoperative blood loss,perioperative blood transfusion rate,positive surgical margin rate,biochemical recurrence and urinary incontinence were recorded(immediately after catheter removal,1 month,3 and6 months postoperatively).Potency was recorded6 months postoperatively.Results All operations were successful.The operation time,estimated blood loss,positive surgical margin rate and transfusion rate was(123.57±53.63)minutes,(225.00±300.77)mL,3/30(10.0%),and 2/30(6.67%),respectively.The average catheter indwelling time was 11(range,8～15)d.Postoperative in continence immediately after Foley catheter removal,and 1 month,3 and 6 months after surgery was 13.33%,53.33%,83.33%and 96.67%,respectively.Of the 25 preoperatively sexually active patients,17(68.0%)were able to erect adequately and perform sexual intercourse 6 months after operation.Biochemical relapse occurred in 2 cases(6.67%)during the follow-up.Conclusion Ligation-free technique for DVC is safe and effective in bilateral intrafascial nerve-sparing laparoscopic radical prostatectomy,which is conducive to the early recovery of continence and sexual function.
引文
[1]顾秀瑛,郑荣寿,张思维,等.2000-2014年中国肿瘤登记地区前列腺癌发病趋势及年龄变化分析[J].中华预防医学杂志,2018,52(6):586-592.
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[6]GANZER R,STOLZENBURG J U,NEUHAUS J,et al.Is the striated urethral sphincter at risk by standard suture ligation of the dorsal vascular complex in radical prostatectomy?an anatomic study[J].Urology,2014,84(6):1453-1460.
[7]GARCIA-SEGUI A.Contemporary refinements in laparoscopic radical prostatectomy[J].Actas Urol Esp,2016,40(8):475-476.
[8]JEONG CW,OH JJ,JEONG SJ,et al.Effect of dorsal vascular complex size on the recovery of continence after radical prostatectomy[J].World J Urol,2013,31(2):383-388.
[9]中国抗癌协会泌尿男生殖系肿瘤专业委员会微创学组.中国前腺癌外科治疗专家共识[J].中华外科杂志,2017,55(10):217-220.
[10]MAXEINER A,MAGHELI A,JHRENS K,et al.Significant reduction in positive surgical margin rate after laparoscopic radical prostatectomy by application of the modified surgical margin recommendations of the 2009international society of urological pathology consensus[J].Bju Int,2016,118(5):750-757.
[11]GARCA-SEGUI,ALEJANDRO,SNCHEZ,MANUEL,VERGES A,et al.Narrowing of the dorsal vein complex technique during laparoscopic radical prostatectomy:a simple trick to simplify the control of venous plexus[J].Urol J,2014,11(5):1873-1877.
[12]BERGMAN A,PATEL T,BERG W,et al.V1277technique of delayed dorsal vein ligation affects apical margin rates during robotic radical prostatectomy[J].J Urol,2013,189(4):e522.
[13]KOJIMA Y,TAKAHASHI N,HAGA N,et al.Urinary incontinence after robot-assisted radical prostatectomy:pathophysiology and intraoperative techniques to improve surgical outcome[J].Int J Urol,2013,20(11):1052-1063.
[14]WALZ J,BURNETT AL,COSTELLO AJ,et al.A critical analysis of the current knowledge of surgical anatomy related to optimization of cancer control and preservation of continence and erection in candidates for radical prostatectomy[J].Eur Urol,2016,70(2):301-311.
[15]TASCI A I,SIMSEK A,TORER B D,et al.Fascia-sparing intrafascial nerve-sparing robot-assisted radical prostatectomy and anatomic vesicourethral anastomosis:point of technique[J].Arch Esp Urol,2014,67(9):731-739.
[16]HOSHI A,USUI Y,SHIMIZU Y,et al.Dorsal vein complex preserving technique for intrafascial nerve-sparing laparoscopic radical prostatectomy[J].Int J Urol,2013,20(5):493-500.
[2]MOTTET N,BELLMUNT J,BOLLA M,et al.Eau-estro-siog guidelines on prostate cancer.part 1:screening,diagnosis,and local treatment with curative intent[J].Eur Urol,2017,71(4):618-629.
[3]PRABHU V,SIVARAJAN G,TAKSLER G B,et al.Long-term continence outcomes in men undergoing radical prostatectomy for clinically localized prostate cancer[J].Eur Urol,2014,65(1):52-57.
[4]CAPPELLERI J C,TSENG L J,LUO X,et al.Simplified interpretation of the erectile function domain of the international index of erectile function[J].J Sex Med,2016,13(4):690-696.
[5]HEIDENREICH A,BASTIAN PJ,BELLMUNT J,et al.EAUguidelines on prostate cancer.part II:treatment of advanced,relapsing,and castration-resistant prostate cancer[J].Eur Urol,2014,65:467-479.
[6]GANZER R,STOLZENBURG J U,NEUHAUS J,et al.Is the striated urethral sphincter at risk by standard suture ligation of the dorsal vascular complex in radical prostatectomy?an anatomic study[J].Urology,2014,84(6):1453-1460.
[7]GARCIA-SEGUI A.Contemporary refinements in laparoscopic radical prostatectomy[J].Actas Urol Esp,2016,40(8):475-476.
[8]JEONG CW,OH JJ,JEONG SJ,et al.Effect of dorsal vascular complex size on the recovery of continence after radical prostatectomy[J].World J Urol,2013,31(2):383-388.
[9]中国抗癌协会泌尿男生殖系肿瘤专业委员会微创学组.中国前腺癌外科治疗专家共识[J].中华外科杂志,2017,55(10):217-220.
[10]MAXEINER A,MAGHELI A,JHRENS K,et al.Significant reduction in positive surgical margin rate after laparoscopic radical prostatectomy by application of the modified surgical margin recommendations of the 2009international society of urological pathology consensus[J].Bju Int,2016,118(5):750-757.
[11]GARCA-SEGUI,ALEJANDRO,SNCHEZ,MANUEL,VERGES A,et al.Narrowing of the dorsal vein complex technique during laparoscopic radical prostatectomy:a simple trick to simplify the control of venous plexus[J].Urol J,2014,11(5):1873-1877.
[12]BERGMAN A,PATEL T,BERG W,et al.V1277technique of delayed dorsal vein ligation affects apical margin rates during robotic radical prostatectomy[J].J Urol,2013,189(4):e522.
[13]KOJIMA Y,TAKAHASHI N,HAGA N,et al.Urinary incontinence after robot-assisted radical prostatectomy:pathophysiology and intraoperative techniques to improve surgical outcome[J].Int J Urol,2013,20(11):1052-1063.
[14]WALZ J,BURNETT AL,COSTELLO AJ,et al.A critical analysis of the current knowledge of surgical anatomy related to optimization of cancer control and preservation of continence and erection in candidates for radical prostatectomy[J].Eur Urol,2016,70(2):301-311.
[15]TASCI A I,SIMSEK A,TORER B D,et al.Fascia-sparing intrafascial nerve-sparing robot-assisted radical prostatectomy and anatomic vesicourethral anastomosis:point of technique[J].Arch Esp Urol,2014,67(9):731-739.
[16]HOSHI A,USUI Y,SHIMIZU Y,et al.Dorsal vein complex preserving technique for intrafascial nerve-sparing laparoscopic radical prostatectomy[J].Int J Urol,2013,20(5):493-500.