CAJ | 학술논문

目的探讨改良的保留神经根治性前列腺癌切除术的临床疗效.方法 30例前列腺癌患者采用改良根治性保留神经的前列腺切除术.改良的关键点:采用注水分离前列腺周围筋膜的方法,将Veil保留神经技术应用于开放手术中(即改良Veil保留神经技术);扩大分区(9区5组)盆腔淋巴结清扫;完整保留膀胱颈;集束捆扎背深静脉复合体;跳针套叠技术行膀胱与尿道的吻合.术后行控尿及勃起功能国际问卷-5(IIEF-5)随访.结果患者平均年龄62岁,前列腺特异性抗原(PSA)水平平均11.9 ng/ml,手术时间平均150 min(75～240 min),术中出血量平均350 ml(100～1 600 ml),术前IIEF-5评分平均为21分,病理分期pT18例、pT2a 15例、pT2b4例、pT3a 3例.Gleason评分5分2例、6分7例、7分20例、8分1例.手术切缘阳性4例,其中2例为T2期,占T2期的10.5％(2/19),2例为T3期.无围手术期严重并发症.平均随访19个月(6-48个月),术后1个月完全控尿27例(90％),3个月达100％.术后3个月和6个月IIEF-5评分分别为13、19分,分别恢复到术前水平的40％和70％.结论对选择性的前列腺癌患者,改良的保留神经根治性前列腺切除术较完整保留了前列腺周围所有的筋膜神经,使术后控尿及性功能得到早期、快速恢复,切缘阳性发生率低,疗效可靠.
목적 탐토개량적보류신경근치성전렬선암절제술적림상료효.방법 30례전렬선암환자채용개량근치성보류신경적전렬선절제술.개량적관건점:채용주수분리전렬선주위근막적방법,장Veil보류신경기술응용우개방수술중(즉개량Veil보류신경기술);확대분구(9구5조)분강림파결청소;완정보류방광경;집속곤찰배심정맥복합체;도침투첩기술행방광여뇨도적문합.술후행공뇨급발기공능국제문권-5(IIEF-5)수방.결과 환자평균년령62세,전렬선특이성항원(PSA)수평평균11.9 ng/ml,수술시간평균150 min(75～240 min),술중출혈량평균350 ml(100～1 600 ml),술전IIEF-5평분평균위21분,병리분기pT18례、pT2a 15례、pT2b4례、pT3a 3례.Gleason평분5분2례、6분7례、7분20례、8분1례.수술절연양성4례,기중2례위T2기,점T2기적10.5％(2/19),2례위T3기.무위수술기엄중병발증.평균수방19개월(6-48개월),술후1개월완전공뇨27례(90％),3개월체100％.술후3개월화6개월IIEF-5평분분별위13、19분,분별회복도술전수평적40％화70％.결론 대선택성적전렬선암환자,개량적보류신경근치성전렬선절제술교완정보류료전렬선주위소유적근막신경,사술후공뇨급성공능득도조기、쾌속회복,절연양성발생솔저,료효가고.
Objective To evaluate the clinical value of the modified nerve-sparing open antegrade retropubic radical prostatectomy (MNS-ORP).Methods MNS-ORPs were performed in 30 patients with clinically localized prostate cancer.The modified technique included: endopelvic fascia was not incised, the prostate capsule was freed laterally from surrounding fasciae and dorsally;using the method of separating the peripheral fascia of the prostate, the Veil technique was applied to the open operation, that is, the modified Veil perserving nerve technology;pelvic lymph node dissections (9 regions and 5 groups) were extended;bladder neck preservation was completed;deep dorsal vein complex was bunched;jumper intussusception technology was applied for bladder and urethral anastomosis.Functional outcomes of continence and sexual function (IIEF-score) were followed-up.Results Median age of patients was 62 years old, and the level of PSA was 11.9 ng/ml.Median operating time was 150 minutes (75-240 minutes), blood loss was 350 ml (100-1 600 ml), preoperative IIEF-score was 21 scores (15-25 scores).Pathologic stage included pT1 (8 cases), pT2a (15 cases), pT2b (4 cases) and pT3a (3 cases).By Gleason score, there were 2 cases of 5 scores, 7 cases of 6 scores, 20 cases of 7 scores and 1 case of 8 scores.4 cases had positive margins including 2 cases (10.5 ％) of pT2 and 2 cases (67 ％) of pT3.There were no postoperative complications.Mean follow-up was 19 months (6-48 months).At the 1st month, 27 patients (90 ％) got full continence, and at the 3rd month, all of the patients had full continence.At the 3rd month and the 6th month, median IIEF-scores were 13 and 19 scores, respectively with baseline of IIEF-score reaching by 40 ％ (at the 3rd month) and 70 ％ (at the 6th month) of preoperative level.Conclusions MNS-ORP follows rationales of radical prostatectomy and might be considered for selected patients.Preserving all periprostatic fasciae/nerves can recover early continence and maintains potency without affecting outcomes.