Liu Xue-Jun, Liu Tian-Yao, Xie Shang-Xun, Sun Yi-Fan, Chen Wei, Yang Yang, Zhang Shi-Wei, Zhang Gu-Tian, Yang Rong, Guo Hong-Qian
Gulou School of Clinical Medicine, Nanjing Medical University, Nanjing, Jiangsu 210008, China.
Department of Urology, Lianyungang Second Hospital, Liangyungang, Jiangsu 222023, China.
Zhonghua Nan Ke Xue. 2019 Sep;25(9):797-801.
To investigate the clinical feasibility and effect of nerve-sparing robot-assisted laparoscopic radical cystectomy (NSRA-LSRC).
We retrospectively reviewed the clinical data on 12 cases of NSRA-LSRC performed from March 2016 to May 2018. The patients were aged 45 to 65 years old and all potent before surgery, with a mean IIEF-5 score of >17. The surgical procedure involved excision of the bladder and prostate and dissection of the pelvic lymph nodes, with preservation of the bilateral neurovascular bundles, internal accessory pudendal artery and pubic bladder complex. All the patients were advised to take PDE5I postoperatively and followed up for the sexual function with the IIEF-5 scores.
Surgical procedures were completed successfully, all with negative surgical margins. Postoperative pathology confirmed invasive high-grade urothelial carcinoma or carcinoma in situ in all the cases, including 11 cases in stage T2N0M0 or below and 1 case in stage T3aN0M0. There were no serious intraoperative or postoperative complications, nor recurrence or metastasis during the follow-up period of 12－36 (20.7 ± 8.0) months. The IIEF-5 scores of the patients at 3, 6 and 12 months after operation were 10.9 ± 6.9, 12.3 ± 6.9 and 14.1 ± 8.0, respectively. At 12 months, satisfactory sexual intercourse was achieved with the help of potency-enhancing medicine in 5 cases (41.7%), penile erection insufficient for sexual intercourse in 3 cases (25%), and no erection in 4 cases (33.3%).
Nerve-sparing robot-assisted laparoscopic radical cystectomy can maximally preserve the sexual function of the patients with urinary bladder carcinoma.
探讨保留神经的机器人辅助腹腔镜根治性膀胱切除术（NSRA-LSRC）的临床可行性及效果。
回顾性分析2016年3月至2018年5月期间行NSRA-LSRC的12例患者的临床资料。患者年龄45至65岁，术前均有性功能，国际勃起功能指数-5（IIEF-5）平均评分>17分。手术过程包括膀胱和前列腺切除以及盆腔淋巴结清扫，同时保留双侧神经血管束、阴部内副动脉和耻骨膀胱复合体。所有患者术后均服用磷酸二酯酶5抑制剂（PDE5I），并采用IIEF-5评分对性功能进行随访。
手术均成功完成，手术切缘均为阴性。术后病理证实所有病例均为浸润性高级别尿路上皮癌或原位癌，其中T2N0M0期及以下11例，T3aN0M0期1例。术中及术后均无严重并发症，在12至36（20.7±8.0）个月的随访期内无复发或转移。患者术后3、6和12个月时的IIEF-5评分分别为10.9±6.9、12.3±6.9和14.1±8.0。12个月时，5例（41.7%）患者在增强性功能药物帮助下实现了满意的性交，3例（25%）患者阴茎勃起不足以进行性交，4例（33.3%）患者无勃起。
保留神经的机器人辅助腹腔镜根治性膀胱切除术可最大程度保留膀胱癌患者的性功能。
