保留神经的开放性根治性前列腺切除术并进行包膜外剥离

[Nerve-sparing open radical prostatectomy with extracapsular dissection].

作者信息

Barré C, Thoulouzan M

机构信息

Clinique Jules Verne, 2-4 route de Paris, Nantes, France.

出版信息

Prog Urol. 2009 Dec;19 Suppl 4:S177-9. doi: 10.1016/S1166-7087(09)73369-X.

DOI:10.1016/S1166-7087(09)73369-X

PMID:20123515

Abstract

BACKGROUND

Potency recovery after radical prostatectomy (RP) has to be weighed against the risks of nerve-sparing surgery in relation to long-term cancer control.

OBJECTIVE

To apply quality control criteria for RP, define the risk of iatrogenic positive margins and evaluate nerve-sparing dissection and sexual outcomes.

INTERVENTION

Nerve-sparing retropubic RP with "extracapsular" dissection.

METHOD

Histopathology : whole-mount 3-mm serial sections from the prostate apex to base using the Stanford technique. Recovery of erectile function evaluated with the abridged version of the International Index for Erectile Function (IIEF-5).

RESULTS

Prospective study about 507 consecutive RP candidates. Bilateral nerve-sparing (n=273, 88.1%), unilateral (n=37, 11.9%). The risk of iatrogenic positive margins was 5%. The positive surgical margin rate was 6.3% (2.2% for pT2 and 14.5% for pT3). The potency recovery rate with or without type 5 phosphodiesterase inhibitor assistance was 83.5% at 1 year and 95.1% at 2 years.

CONCLUSION

Nerve-sparing can be performed in a dissection plane outside the boundaries of the capsule, thus ensuring oncological safety whilst providing highly satisfactory potency recovery rates.

摘要

背景

根治性前列腺切除术（RP）后的性功能恢复必须与保留神经手术在长期癌症控制方面的风险相权衡。

目的

应用RP的质量控制标准，确定医源性切缘阳性的风险，并评估保留神经的解剖和性功能结果。

干预措施

采用“包膜外”解剖的保留神经耻骨后RP。

方法

组织病理学：使用斯坦福技术从前列腺尖部到基部制作3毫米连续全层切片。使用国际勃起功能指数简版（IIEF-5）评估勃起功能恢复情况。

结果

对507例连续的RP候选者进行前瞻性研究。双侧保留神经（n = 273，88.1%），单侧保留神经（n = 37，11.9%）。医源性切缘阳性的风险为5%。手术切缘阳性率为6.3%（pT2为2.2%，pT3为14.5%）。在有或没有5型磷酸二酯酶抑制剂辅助的情况下，1年时性功能恢复率为83.5%，2年时为95.1%。