Srinualnad Sittiporn, Nualyong Chaiyong
Division of Urology, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Bangkok, Thailand.
J Med Assoc Thai. 2007 Apr;90(4):730-6.
Quality of life after laparoscopic radical prostatectomy has been a discussed issue among patients. Nerve-sparing radical prostatectomy has been shown to be superior to non-nerve-sparing radical prostatectomy in terms of potency and continence. The authors have reported their experience of laparoscopic radical prostatectomy and now developed our technique of nerve-sparing laparoscopic radical prostatectomy.
To evaluate the feasibility of nerve-sparing laparoscopic radical prostatectomy done at our institute.
From December 2005 to August 2006, 28 patients with localized prostate cancer underwent a nerve-sparing laparoscopic radical prostatectomy. Perioperative data was compared to those 34 patients who underwent non-nerve-sparing laparoscopic radical prostatectomy during the same period. All patients had PSA of less than 10 and pre-operative Gleason Score of 7 or less. Quality of life including incontinence and impotency rates was analyzed during three months post-operation.
Patients' dermographic data, except ages, was similar in the two groups. Operating time was not different (217 vs. 212 minutes in favor of nerve-sparing). Blood loss was significantly high in nerve-sparing laparoscopic radical prostatectomy (814 mls vs. 543 mls, p = 0.01). Tumor control was not different within both groups. Three months after surgery incontinent rates of both groups were not different. 43.75% of patients with nerve-sparing technique had experienced erection at three months after surgery.
The authors' early experience has shown that nerve-sparing laparoscopic radical prostatectomy does not compromise cancer control, although blood loss is higher. This operation should be encouraged in cancer-localized patients as the patients may gain benefit of better quality of life.
腹腔镜根治性前列腺切除术后的生活质量一直是患者们讨论的问题。保留神经的根治性前列腺切除术在性功能和控尿方面已被证明优于不保留神经的根治性前列腺切除术。作者已报告了他们腹腔镜根治性前列腺切除术的经验，现在又开发了保留神经的腹腔镜根治性前列腺切除术技术。
评估在本机构进行保留神经的腹腔镜根治性前列腺切除术的可行性。
2005年12月至2006年8月，28例局限性前列腺癌患者接受了保留神经的腹腔镜根治性前列腺切除术。将围手术期数据与同期接受不保留神经的腹腔镜根治性前列腺切除术的34例患者的数据进行比较。所有患者的前列腺特异性抗原（PSA）均低于10，术前Gleason评分均为7分或更低。在术后三个月分析包括尿失禁和阳痿发生率在内的生活质量。
两组患者的人口统计学数据（年龄除外）相似。手术时间无差异（保留神经组为217分钟，不保留神经组为212分钟，保留神经组稍长）。保留神经的腹腔镜根治性前列腺切除术的失血量显著更高（814毫升对543毫升，p = 0.01）。两组的肿瘤控制情况无差异。术后三个月，两组的尿失禁发生率无差异。保留神经技术组43.75%的患者在术后三个月有勃起现象。
作者的早期经验表明，保留神经的腹腔镜根治性前列腺切除术虽然失血量更高，但并不影响癌症控制。对于局限性癌症患者，应鼓励进行这种手术，因为患者可能会从更好的生活质量中获益。
