Department of Urology, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
Int J Urol. 2013 May;20(5):493-500. doi: 10.1111/j.1442-2042.2012.03181.x. Epub 2012 Oct 8.
To describe a novel dorsal vein complex preserving technique for intrafascial nerve-sparing laparoscopic radical prostatectomy and to evaluate its postoperative outcomes.
A total of 109 patients who underwent laparoscopic radical prostatectomy by a single surgeon were evaluated, including 44 patients with dorsal vein complex preserving technique for intrafascial nerve-sparing laparoscopic radical prostatectomy, 20 patients with conventional intrafascial nerve-sparing laparoscopic radical prostatectomy and 45 patients with non-nerve-sparing laparoscopic radical prostatectomy. Functional outcomes were evaluated using a self-administered questionnaire (Expanded Prostate Cancer Index Composite). Continence was defined as zero to one security pad per day. Oncological outcomes were evaluated based on positive surgical margin.
In the dorsal vein complex preserving technique for intrafascial nerve-sparing laparoscopic radical prostatectomy group, the continence rate was 57%, 77% and 95% at 1, 3 and 12 months, respectively. The continence rate in the conventional intrafascial nerve-sparing laparoscopic radical prostatectomy group was 37%, 63% and 90%, and in the non-nerve-sparing laparoscopic radical prostatectomy group it was 23%, 57% and 82% at 1, 3, and 12 months, respectively. The dorsal vein complex preserving technique for intrafascial nerve-sparing laparoscopic radical prostatectomy group showed a significantly earlier recovery from incontinence compared with that in the conventional intrafascial nerve-sparing laparoscopic radical prostatectomy and non-nerve-sparing laparoscopic radical prostatectomy groups (log-rank test, P = 0.044 and P < 0.001). Similarly, the dorsal vein complex preserving technique for intrafascial nerve-sparing laparoscopic radical prostatectomy group tended to show a more early recovery in relation to urinary function of the Expanded Prostate Cancer Index Composite. Regarding sexual function, there were no significant differences between the dorsal vein complex preserving technique for intrafascial nerve-sparing laparoscopic radical prostatectomy and conventional intrafascial nerve-sparing laparoscopic radical prostatectomy groups. In pT2 patients, the positive surgical margin rate of the dorsal vein complex preserving technique for intrafascial nerve-sparing laparoscopic radical prostatectomy group (11%) was similar to that of the other two groups (conventional intrafascial nerve-sparing laparoscopic radical prostatectomy 7%; non-nerve-sparing laparoscopic radical prostatectomy 11%).
The dorsal vein complex preserving technique for intrafascial nerve-sparing laparoscopic radical prostatectomy technique provides early recovery from incontinence without adversely affecting the oncological outcome.
描述一种新的筋膜内神经保留的背静脉复合体保护技术，并评估其术后效果。
对 109 例行单刀手术的腹腔镜根治性前列腺切除术患者进行评估，其中 44 例行筋膜内神经保留的背静脉复合体保护技术腹腔镜根治性前列腺切除术，20 例行常规筋膜内神经保留腹腔镜根治性前列腺切除术，45 例行非神经保留腹腔镜根治性前列腺切除术。采用自我管理问卷（前列腺癌指数综合评估）评估功能结局。控尿定义为每天零至一片护垫。根据切缘阳性评估肿瘤学结局。
在筋膜内神经保留的背静脉复合体保护技术腹腔镜根治性前列腺切除术组中，术后 1、3、12 个月的控尿率分别为 57%、77%和 95%。常规筋膜内神经保留腹腔镜根治性前列腺切除术组的控尿率分别为 37%、63%和 90%，非神经保留腹腔镜根治性前列腺切除术组分别为 23%、57%和 82%。与常规筋膜内神经保留腹腔镜根治性前列腺切除术和非神经保留腹腔镜根治性前列腺切除术组相比，筋膜内神经保留的背静脉复合体保护技术腹腔镜根治性前列腺切除术组更早恢复控尿（对数秩检验，P=0.044 和 P<0.001）。同样，与常规筋膜内神经保留腹腔镜根治性前列腺切除术组相比，筋膜内神经保留的背静脉复合体保护技术腹腔镜根治性前列腺切除术组在改善前列腺癌指数综合评估的尿功能方面也更早恢复。关于性功能，筋膜内神经保留的背静脉复合体保护技术腹腔镜根治性前列腺切除术组与常规筋膜内神经保留腹腔镜根治性前列腺切除术组之间无显著差异。在 pT2 患者中，筋膜内神经保留的背静脉复合体保护技术腹腔镜根治性前列腺切除术组（11%）的阳性切缘率与其他两组（常规筋膜内神经保留腹腔镜根治性前列腺切除术 7%；非神经保留腹腔镜根治性前列腺切除术 11%）相似。
筋膜内神经保留的背静脉复合体保护技术腹腔镜根治性前列腺切除术可早期恢复控尿，而不影响肿瘤学结果。
