Golabek Tomasz, Jaskulski Jaroslaw, Jarecki Piotr, Dudek Przemysław, Szopiński Tomasz, Chłosta Piotr
Department of Urology, Jagiellonian University Medical College, Krakow, Poland.
Department of Urology, Institute of Oncology, Kielce, Poland.
Wideochir Inne Tech Maloinwazyjne. 2014 Sep;9(3):362-70. doi: 10.5114/wiitm.2014.45085. Epub 2014 Sep 5.
Preservation of the bladder neck (BN) has been controversial, as limited excision of the bladder neck may result in incomplete resection of the disease. Moreover, the urinary continence rate may not be improved.
To evaluate the effect of bladder neck sparing on urinary continence, and surgical margins status in prostate cancer (PCa) patients treated with laparoscopic radical extraperitoneal prostatectomy.
A retrospective analysis of 295 consecutive patients who had undergone laparoscopic radical extraperitoneal prostatectomy for clinically localised prostate cancer in a single institution was performed. Positive surgical margin (SM(+)) and urinary continence status at 3, 6, and 12 months were evaluated.
The distribution of SM(+) for pT2, pT3, and pT4a was 15.3% (27/176), 49.1% (58/118), and 100% (1/1), respectively. Overall, there were 55.61%, 80.61%, and 84.69% of men continent at 3, 6, and 12 months, respectively. However, when limiting the analysis to those who did not receive adjuvant radiotherapy within 12 months following surgery, urinary continence rates were 59.23%, 85.86%, and 90.21% at 3, 6, and 12 months, respectively. Preoperative prostate-specific antigen (PSA) and pathological T stage were identified as significant predictors of positive surgical margins.
Laparoscopic radical extraperitoneal prostatectomy with bladder neck preservation has been a safe procedure which has resulted in good functional outcome. We observed a relatively high incidence of positive surgical margins which could be attributed to a large number of extracapsular disease cases.
膀胱颈（BN）的保留一直存在争议，因为膀胱颈的有限切除可能导致疾病切除不完全。此外，尿失禁率可能无法提高。
评估保留膀胱颈对接受腹腔镜根治性腹膜外前列腺切除术的前列腺癌（PCa）患者尿失禁及手术切缘状态的影响。
对在单一机构接受腹腔镜根治性腹膜外前列腺切除术治疗临床局限性前列腺癌的295例连续患者进行回顾性分析。评估手术切缘阳性（SM(+)）情况以及术后3、6和12个月时的尿失禁状态。
pT2、pT3和pT4a期患者的SM(+)分布分别为15.3%（27/176）、49.1%（58/118）和100%（1/1）。总体而言，术后3、6和12个月时分别有55.61%、80.61%和84.69%的男性保持尿失禁。然而，当将分析局限于术后12个月内未接受辅助放疗的患者时，术后3、6和12个月时的尿失禁率分别为59.23%、85.86%和90.21%。术前前列腺特异性抗原（PSA）和病理T分期被确定为手术切缘阳性的显著预测因素。
保留膀胱颈的腹腔镜根治性腹膜外前列腺切除术是一种安全的手术，功能预后良好。我们观察到手术切缘阳性的发生率相对较高，这可能归因于大量包膜外疾病病例。
