Eggleston J C, Walsh P C
J Urol. 1985 Dec;134(6):1146-8. doi: 10.1016/s0022-5347(17)47661-0.
In an effort to preserve sexual function, a nerve-sparing technique for radical retropubic prostatectomy has been used in 100 consecutive men with clinically localized prostatic cancer. Each gland was submitted for total histological examination in a way that permitted determination of the extent of the tumor and adequacy of surgical margins. Although 41 patients had established tumor in periprostatic tissue only 7 had positive surgical margins: all 7 had extensive extraprostatic involvement by tumor, while 5 had involvement of the seminal vesicles and none had surgical margins positive only at the site of the nerve-sparing modification. Sexual function was evaluated in 60 of the patients who were potent preoperatively and who have been followed for a minimum of 1 year: 84 per cent of the patients with an intact prostatic capsule were potent compared to 43 per cent with extensive involvement of periprostatic tissue and 33 per cent with involvement of the seminal vesicles or pelvic lymph nodes. Based upon our findings there is no indication that the nerve-sparing modification compromises the adequacy of the removal of the cancer, which is determined primarily by the extent of the tumor rather than the operative technique. Thus, it appears possible to preserve sexual function in a majority of patients undergoing radical prostatectomy without compromising the adequacy of the cancer operation.
为了保留性功能，一种保留神经的耻骨后根治性前列腺切除术技术已应用于100例连续的临床局限性前列腺癌男性患者。每个腺体均进行了全组织学检查，以便确定肿瘤范围和手术切缘是否足够。虽然41例患者仅在前列腺周围组织中有明确的肿瘤，但只有7例手术切缘阳性：所有7例均有广泛的前列腺外肿瘤侵犯，5例有精囊侵犯，且无仅在保留神经改良部位手术切缘阳性的情况。对60例术前有性功能且随访至少1年的患者进行了性功能评估：前列腺包膜完整的患者中84%仍有性功能，而前列腺周围组织广泛侵犯的患者为43%，精囊或盆腔淋巴结侵犯的患者为33%。根据我们的研究结果，没有迹象表明保留神经的改良会损害癌症切除的充分性，癌症切除的充分性主要取决于肿瘤范围而非手术技术。因此，在大多数接受根治性前列腺切除术的患者中，似乎有可能在不影响癌症手术充分性的情况下保留性功能。
