Potdevin Lindsay, Ercolani Matt, Jeong Jeongyun, Kim Isaac Yi
Section of Urologic Oncology, The Cancer Institute of New Jersey, Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
J Endourol. 2009 Sep;23(9):1479-84. doi: 10.1089/end.2009.0369.
The impact of intrafascial versus interfascial nerve sparing during radical prostatectomy on oncologic and postoperative outcome is still controversial. This manuscript compares the outcomes of intrafascial versus interfascial techniques of nerve sparing used during robot-assisted laparoscopic radical prostatectomy (RALRP) at our institution.
Of the 171 patients who underwent RALRP at our institution from January 2006 through December 2007, the charts of 147 patients who underwent bilateral nerve sparing procedure were reviewed retrospectively. During the study period, the preferred technique of nerve sparing at our institution changed from the conventional interfascial approach to athermal intrafascial robotic (AIR) approach. The rates of positive surgical margins (+SMs), continence, and potency were measured.
Perioperative characteristics and complication rates were similar between the two groups. Continence rates at 1, 3, and 6 months increased from 27.3%, 68.8%, and 93.5%, respectively, after the interfascial procedure to 68.6%, 84.3%, and 92.9% after the AIR procedure. Potency rates at 3, 6, and 9 months in the interfascial group were 16.7%, 43.8%, and 66.7%, respectively, whereas in the AIR group they improved to 24.2%, 81.8%, and 90.9%. The rates of +SMs in pT2 disease were 5.88% in the interfascial group and 7.55% in the AIR group (not significant), whereas in pT3, +SMs were 22.2% in the interfascial group and 41.18% in the AIR group (p < 0.05).
AIR technique greatly improved potency rate and shortened the time to return of continence following RALRP. This improved outcome, though, was achieved at the price of higher +SM rates in patients with pT3 disease.
根治性前列腺切除术中筋膜内与筋膜间保留神经对肿瘤学及术后结果的影响仍存在争议。本文比较了我院机器人辅助腹腔镜根治性前列腺切除术（RALRP）中筋膜内与筋膜间保留神经技术的结果。
回顾性分析了2006年1月至2007年12月在我院接受RALRP的171例患者的病历，其中147例行双侧神经保留手术。在研究期间，我院首选的神经保留技术从传统的筋膜间方法转变为非热筋膜内机器人（AIR）方法。测量手术切缘阳性（+SMs）率、控尿率和性功能恢复率。
两组围手术期特征和并发症发生率相似。筋膜间手术后1个月、3个月和6个月的控尿率分别从27.3%、68.8%和93.5%提高到AIR手术后的68.6%、84.3%和92.9%。筋膜间组3个月、6个月和9个月的性功能恢复率分别为16.7%、43.8%和66.7%，而AIR组分别提高到24.2%、81.8%和90.9%。pT2疾病中+SMs率在筋膜间组为5.88%，AIR组为7.55%（无统计学意义），而在pT3中，筋膜间组为22.2%，AIR组为41.18%（p<0.05）。
AIR技术显著提高了RALRP后的性功能恢复率，并缩短了控尿恢复时间。然而，这一改善是以pT3疾病患者较高的+SMs率为代价的。
