Huang Yi-ran, Wang Yuan-tian, Xue Wei, Liu Dong-ming, Zhou Li-xin
Department of Urology, Renji Hospital, Shanghai Jiaotong University Medical College, Shanghai 200127, China.
Zhonghua Wai Ke Za Zhi. 2006 Mar 15;44(6):365-8.
To summarize the experience of radical retropubic prostatectomy (RRP) and the multi-factors which influence on the prognosis and long life quality.
From January 1993 to March 2005, 132 cases radical retropubic prostatectomy were performed. The patients were divided into 2 groups: the early group and recent group. Eleven items in peri-operative time and follow up results were analysed. The erection function of 78 cases were investigated with international index of erectile function 5 score. In these patients, nocturnal electrobioimpedance volumetric assessment (NEVA) were observe in 19 cases.
Comparing of the 2 groups, the index connected with operative skill changed to optimization. No one died of prostate cancer in 63 follow up patients. Nine cases showed biochemical failure with criterion as prostate specific antigen > 0.4 microg/L. Fifty patients passed urine normal post-operation in 6 months. Eight patients had stress incontinence and 5 had entire incontinence at 6 month. Four patients had vesical neck stricture. Another follow up result shows 33 (58.9%) erection function recovered in 55 bilateral nerve-sparing operation and 7 recovered in 22 of unilateral nerve-sparing operation. NEVA shows 14 cases with artery supply insufficient in whom 4 regained erection function and 5 cases vein leakage in whom no one recovered.
The radical retropubic prostatectomy remains the procedure of choice for the cure of localized prostatic cancer. The keys for the operation are anatomic dissection, preservation of the neurovascular bundle and good skill. These are also important for a good life quality for the patients.
总结耻骨后根治性前列腺切除术（RRP）的经验以及影响预后和长期生活质量的多因素。
1993年1月至2005年3月，行耻骨后根治性前列腺切除术132例。患者分为两组：早期组和近期组。分析围手术期及随访结果中的11项指标。采用国际勃起功能指数5分法对78例患者的勃起功能进行调查。其中19例患者进行了夜间生物电阻抗容积评估（NEVA）。
两组比较，与手术技巧相关的指标有所优化。63例随访患者中无1例死于前列腺癌。9例出现生化失败，标准为前列腺特异性抗原>0.4μg/L。6个月时50例患者术后排尿正常。6个月时8例患者出现压力性尿失禁，5例完全失禁。4例患者出现膀胱颈狭窄。另一随访结果显示，55例双侧神经保留手术中有33例（58.9%）勃起功能恢复，22例单侧神经保留手术中有7例恢复。NEVA显示14例动脉供血不足，其中4例恢复勃起功能；5例静脉漏，无1例恢复。
耻骨后根治性前列腺切除术仍是治疗局限性前列腺癌的首选术式。手术的关键在于解剖分离、保留神经血管束及良好的手术技巧。这些对患者良好的生活质量也很重要。
