Royal Surrey County Hospital, Guildford, Surrey, UK.
BJU Int. 2009 Dec;104(11):1730-3. doi: 10.1111/j.1464-410x.2009.08670.x.
To assess whether oncological outcomes are compromised by adopting the curtain dissection (CD) technique (high incision of the peri-prostatic fascia) during nerve-preserving radical prostatectomy (RP).
In all, 973 laparoscopic RPs (LRPs) were performed or supervised by one surgeon between March 2000 and October 2007 for cT1-3 N0M0 prostate cancer, of which 510 included bilateral neurovascular bundle preservation. A CD technique was used in 240 men and a standard dissection (StD) technique was used in 270, considered the control group. The technique was extraperitoneal, used five ports and included preservation of the seminal vesicle tips. Thermal energy was not used posterior or lateral to the prostate in either group. Patient, operative and oncological outcome variables were compared using an independent-sample t-test if continuous or with Fisher's exact test for rates.
Patient and cancer characteristics before LRP were similar for the CD and StD groups, and there were no significant perioperative differences either. Positive margins occurred in 11.7% of the CD group and 11.1% of the StD group (P = 0.95). At a mean (range) follow-up of 11.7 (3-24) months for the CD group and 13.1 (3-24) months for the StD group, biochemical recurrence rates were 0% and 1.1%, respectively (P = 0.30). Potency (CD, 62%; StD, 61%; P = 0.89) and continence rates (StD, 97%; CD, 98%; P = 0.83) were comparable between the groups, but there was a statistically significant earlier return to continence in the CD group (P < 0.001 at 3 months).
For carefully selected men there appears to be no compromise in cancer control with intrafascial dissection in the short term. However, equally there appears to be no significant improvement in potency after LRP. The earlier return to continence after intrafascial nerve-sparing suggests reduced dissection of periurethral supports rather than preservation of additional autonomic nerve fibres.
评估在保留神经的根治性前列腺切除术（RP）中采用幕式解剖（CD）技术（前列腺筋膜的高位切开）是否会影响肿瘤学结果。
2000 年 3 月至 2007 年 10 月，一位外科医生共进行了 973 例腹腔镜 RP（LRP），用于治疗 cT1-3 N0M0 前列腺癌，其中 510 例包括双侧神经血管束保留。240 例患者采用 CD 技术，270 例患者采用标准解剖（StD）技术作为对照组。该技术为腹膜外入路，使用 5 个端口，包括保留精囊尖端。两组均不使用热能在前列腺的后部或侧部进行解剖。使用独立样本 t 检验比较患者、手术和肿瘤学结果变量，如果是连续变量，则使用 Fisher 确切检验比较率。
LRP 前患者和癌症特征在 CD 组和 StD 组之间相似，围手术期也没有显著差异。CD 组阳性切缘发生率为 11.7%，StD 组为 11.1%（P = 0.95）。CD 组平均（范围）随访时间为 11.7（3-24）个月，StD 组为 13.1（3-24）个月，生化复发率分别为 0%和 1.1%（P = 0.30）。两组之间的勃起功能（CD 组 62%；StD 组 61%；P = 0.89）和控尿功能（StD 组 97%；CD 组 98%；P = 0.83）相似，但 CD 组的控尿功能更早恢复（3 个月时 P < 0.001）。
对于精心选择的患者，短期内采用筋膜内解剖似乎不会影响肿瘤控制。然而，LRP 后勃起功能的改善似乎也不明显。CD 组在筋膜内保留神经后更快恢复控尿功能，这表明对尿道周围支持结构的解剖减少，而不是保留更多的自主神经纤维。
