Ruckle H C, Zincke H
Department of Urology, Mayo Clinic, Rochester, Minnesota, USA.
J Urol. 1995 Jun;153(6):1875-7.
A simplified method of nerve sparing radical retropubic prostatectomy for clinical stage T2a prostate cancer is described based on primary isolation of both neurovascular bundles and secondary division of the urethra, with the puboprostatic ligaments undivided to provide suspension of the deep venous complex above the urethra. The principles for this approach after division of the deep vein complex are based on early unilateral incision of the prostatic fascia laterally, parallel to the ipsilateral neurovascular bundle and extending from the proximal prostate to the urethra; separation of anterior (prostatic) and posterior (rectal) Denonilliers' fascia, which leaves the neurovascular bundle invested in the latter tissue; perforation and incision of contralateral prostatic fascia at its urethroprostatic angle, with cranial extension of the fascial opening dropping the ipsilateral neurovascular bundle invested in its fascia (Denonvilliers' posterior), and anastomotic division of the urethra at its entrance into the prostate.
描述了一种用于临床分期为T2a期前列腺癌的保留神经的耻骨后根治性前列腺切除术的简化方法，该方法基于首先分离双侧神经血管束，其次离断尿道，耻骨前列腺韧带保持完整以悬吊尿道上方的深部静脉丛。离断深部静脉丛后该方法的原则是：早期在前列腺筋膜外侧作单侧切口，平行于同侧神经血管束并从前列腺近端延伸至尿道；分离前列腺前方（前列腺）和后方（直肠）的狄氏筋膜，使神经血管束保留在后一种组织中；在对侧前列腺筋膜的尿道前列腺角处穿孔并切开，筋膜开口向上延伸使同侧神经血管束（狄氏筋膜后方）落入其中，以及在尿道进入前列腺处离断尿道进行吻合。
