Weldon V E, Tavel F R, Neuwirth H
Department of Urology, University of California, San Francisco, USA.
J Urol. 1997 Oct;158(4):1470-5.
We investigated continence, potency and morbidity rates associated with radical perineal prostatectomy.
We assessed 220 consecutive men who underwent radical perineal prostatectomy for clinically localized prostate cancer between January 1984 and July 1995. Concomitant pelvic lymphadenectomy was performed in 181 patients. Potency was assessed in a subset of 50 consecutive men with good preoperative potency and a minimum 18-month followup who were otherwise candidates for a nerve sparing procedure (22 bilateral and 28 unilateral). Continence and potency were prospectively evaluated.
Continence was preserved in 208 of the 220 men (95%), and it returned in 23% by 1 month, 56% by 3, 90% by 6 and 95% by 10. Advanced age was the only significant risk factor. All 12 incontinent men (5%) were 69 years old or older and they represented 12% of that age group (12 of 103). After nerve sparing potency was preserved in 35 of the 50 fully potent men (70%), returning in 24% by 6 months, 50% by 12, 64% by 18 and 70% by 24. Unilateral nerve sparing preserved potency in 19 of 28 men (68%). There were no deaths but serious morbidity developed in 5 patients (2%). Anastomotic stricture, inadvertent proctotomy and venous thromboembolism occurred in 3 men (1%), respectively. Median operative blood loss was 600 ml. and 208 men (95%) had blood loss of 1,200 ml. or less. Median total hospital stay is now 2 days.
Radical perineal prostatectomy is safe. In our 220 patients there were no deaths and serious morbidity developed in 2%. The continence rate was 95% and 70% of a select group recovered potency.
我们研究了根治性会阴前列腺切除术相关的控尿、性功能及发病率情况。
我们评估了1984年1月至1995年7月期间连续220例因临床局限性前列腺癌接受根治性会阴前列腺切除术的男性患者。181例患者同时进行了盆腔淋巴结清扫术。对50例连续的术前性功能良好且至少随访18个月的男性患者进行了性功能评估，这些患者原本均为保留神经手术的候选对象（22例双侧，28例单侧）。控尿和性功能进行了前瞻性评估。
220例男性中有208例（95%）保留了控尿功能，术后1个月恢复控尿功能的比例为23%，3个月时为56%，6个月时为90%，10个月时为95%。高龄是唯一显著的危险因素。所有12例控尿功能未恢复的男性（5%）年龄均在69岁及以上，占该年龄组的12%（103例中的12例）。50例性功能完全正常的男性中，35例（70%）保留了保留神经手术后的性功能，术后6个月恢复性功能的比例为24%，12个月时为50%，18个月时为64%，24个月时为70%。28例单侧保留神经手术的男性中有19例（68%）保留了性功能。无死亡病例，但5例患者（2%）出现了严重并发症。分别有3例男性（1%）发生吻合口狭窄、意外直肠切开术和静脉血栓栓塞。术中中位失血量为600毫升，208例男性（95%）失血量为1200毫升或更少。目前住院总中位天数为2天。
根治性会阴前列腺切除术是安全的。在我们的220例患者中无死亡病例，2%的患者出现严重并发症。控尿率为95%，特定组中有70%的患者恢复了性功能。
