Quinlan D M, Epstein J I, Carter B S, Walsh P C
Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland 21205.
J Urol. 1991 May;145(5):998-1002. doi: 10.1016/s0022-5347(17)38512-9.
The influence of preservation or excision of the neurovascular bundles on return of sexual function is analyzed. Between 1982 and 1988, 600 men 34 to 72 years old underwent radical retropubic prostatectomy for prostate cancer. Of the 503 patients who were potent preoperatively and followed for a minimum of 18 months 342 (68%) are potent postoperatively. Three factors were identified that correlated with the return of sexual function: 1) age, 2) clinical and pathological stage, and 3) surgical technique (preservation or excision of the neurovascular bundle). In men less than 50 years old potency was similar in patients who had both neurovascular bundles preserved (90%) and patients who had 1 neurovascular bundle widely excised (91%). With advancing age of more than 50 years sexual function was better in patients in whom both neurovascular bundles were preserved than in patients in whom 1 neurovascular bundle was excised (p less than 0.05). When the relative risk of postoperative impotence was adjusted for age the risk of postoperative impotence was 2-fold greater if there was capsular penetration or seminal vesicle invasion, or if 1 neurovascular bundle was excised (p less than 0.05). These data indicate that the return of sexual function postoperatively in men more than 50 years old is quantitatively related to preservation of autonomic innervation. In these men when it is necessary to excise the neurovascular bundle on 1 side, consideration in the future should be given to approaches that may restore autonomic function through nerve regeneration, for example partial excision of the bundle or cavernous nerve grafts.
分析了保留或切除神经血管束对性功能恢复的影响。1982年至1988年间，600名34至72岁的男性因前列腺癌接受了耻骨后根治性前列腺切除术。在术前有性功能且随访至少18个月的503例患者中，342例（68%）术后仍有性功能。确定了与性功能恢复相关的三个因素：1）年龄，2）临床和病理分期，3）手术技术（保留或切除神经血管束）。在年龄小于50岁的男性中，保留双侧神经血管束的患者（90%）和广泛切除一侧神经血管束的患者（91%）性功能相似。随着年龄超过50岁，保留双侧神经血管束的患者性功能比切除一侧神经血管束的患者更好（p<0.05）。当根据年龄调整术后阳痿的相对风险时，如果有包膜侵犯或精囊侵犯，或切除一侧神经血管束，术后阳痿的风险会增加两倍（p<0.05）。这些数据表明，50岁以上男性术后性功能的恢复与自主神经支配的保留在数量上相关。对于这些男性，当有必要切除一侧神经血管束时，未来应考虑通过神经再生恢复自主神经功能的方法，例如部分切除神经血管束或进行海绵体神经移植。
