无热能腹腔镜保留神经根治性前列腺切除术：一年性功能结果

Thermal energy-free laparoscopic nerve-sparing radical prostatectomy: one-year potency outcomes.

作者信息

Gill Inderbir S, Ukimura Osamu

机构信息

Section of Laparoscopic and Robotic Surgery, Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.

出版信息

Urology. 2007 Aug;70(2):309-14. doi: 10.1016/j.urology.2007.03.072.

DOI:10.1016/j.urology.2007.03.072

PMID:17826495

Abstract

OBJECTIVES

We recently described a novel, energy-free technique of nerve-sparing laparoscopic radical prostatectomy performed with transrectal ultrasound guidance. We provide our current technique and updated experience with 169 patients and report the potency outcomes of this energy-free, clip-free, bioadhesive-free, nerve-sparing laparoscopic radical prostatectomy.

METHODS

Our technique involves transient bulldog clamping of the lateral pedicle, cold-cut release of the neurovascular bundle, and delicate hemostatic suturing. One-year follow-up data were available for 110 patients, of whom 76 (69%) had paired preoperative and 1-year postoperative Sexual Health Inventory for Men data. These 76 men included 22 patients undergoing the earlier thermal-energy based technique using an ultrasonic scalpel (group 1) and 54 patients undergoing the novel energy-free technique (group 2).

RESULTS

In the patients with complete potency preoperatively (Sexual Health Inventory for Men score of 22 or more), the 1-year intercourse rate in groups 1 and 2 was 71% and 88%, respectively (P = 0.4), and the Sexual Health Inventory for Men score in group 1 versus group 2 was 5.3 versus 10.9 at 3 months (P = 0.001) and 7.5 versus 14.1 at 6 months (P = 0.02), respectively. Within the entire study group, the overall 1-year intercourse rate was superior in group 2 (36% versus 70%; P = 0.04). Erectile function recovered faster in group 2 patients. Erectile function recovery correlated significantly with preserved pulsatile blood vessels within the neurovascular bundle (P = 0.0001) on power Doppler transrectal ultrasonography.

CONCLUSIONS

The elimination of electrical and thermal energy during nerve-sparing laparoscopic radical prostatectomy achieved superior and quicker potency recovery. The energy-free nerve-sparing technique and power Doppler-confirmed preserved pulsatile blood vessels within the neurovascular bundle correlated with superior erectile function recovery, a novel observation.

摘要

目的

我们最近描述了一种在经直肠超声引导下进行的新型无能量保留神经的腹腔镜根治性前列腺切除术技术。我们介绍了目前针对169例患者的技术及最新经验，并报告了这种无能量、无夹子、无生物粘合剂、保留神经的腹腔镜根治性前列腺切除术的性功能结果。

方法

我们的技术包括临时用牛头夹夹住侧蒂、冷切释放神经血管束以及精细的止血缝合。110例患者有1年的随访数据，其中76例（69%）有术前及术后1年的男性性功能健康量表数据。这76名男性包括22例采用早期基于热能技术（使用超声刀）的患者（第1组）和54例采用新型无能量技术的患者（第2组）。

结果

术前性功能完全正常（男性性功能健康量表评分22分及以上）的患者中，第1组和第2组的1年性交率分别为71%和88%（P = 0.4），第1组与第2组在3个月时的男性性功能健康量表评分分别为5.3分和10.9分（P = 0.001），在6个月时分别为7.5分和14.1分（P = 0.02）。在整个研究组中，第2组的总体1年性交率更高（36%对70%；P = 0.04）。第2组患者的勃起功能恢复更快。经直肠超声造影显示，勃起功能恢复与神经血管束内保留的搏动性血管显著相关（P = 0.0001）。