筋膜内与筋膜间保留神经的腹膜外腹腔镜前列腺癌根治术临床效果的比较

摘要

目的：比较筋膜内与筋膜间保留神经的腹膜外腹腔镜前列腺癌根治术的临床效果。方法选择2010年3月到2011年8月间65例行筋膜内保留神经的腹膜外腹腔镜前列腺癌根治术的局限性前列腺癌患者为筋膜内组。选择2008年1月到2011年8月间130例行筋膜间保留神经的腹膜外腹腔镜前列腺癌根治术的局限性前列腺癌患者为筋膜间组，进行2∶1配对比较。结果两组之间的围手术期数据、病理学分期及切缘阳性率无显著差异。筋膜内组有9例失访，筋膜间组有13例失访。术后3个月、6个月随访，筋膜内组较筋膜间组控尿功能恢复快。术后12个月随访两组控尿功能恢复比较差异无统计学意义。术后6个月、12个月随访发现筋膜内组患者总体及年轻患者(≤65岁)的勃起功能恢复好于筋膜间组。术后2年两组的无生化进展生存率相似。结论在严格按照适应证的前提下，筋膜内与筋膜间保留神经的腹膜外腹腔镜前列腺癌根治术比较，筋膜内组控尿功能恢复较快，勃起功能恢复较好，而手术效果、短期肿瘤学结果相似。对于临床分期为 cT1-cT2 a、术前勃起功能正常的年轻前列腺癌患者，推荐优先采用筋膜内保留神经的前列腺癌根治术。%Objective To compare the efficacy of the intrafascial nerve-sparing technique with that of interfascial nerve-sparing technique in extraperitoneal laparoscopic radical prostatectomy for the treatment of prostate cancer.Methods From March 2010 to August 2011,65 patients with localized prostate cancer(PCa)underwent bilateral intrafascial nerve-sparing ex-traperitoneal laparoscopic radical prostatectomy.These patients were matched at a ratio of 2∶1 to 130 patients with localized PCa who had undergone bilateral interfascial nerve-sparing extraperitoneal laparoscopic radical prostatectomy between January 2008 and August 2011 and the relevant data were compared.Results There were no significant differences in peri-operative da-ta,pathological stages and positive rates of surgical margins between the groups.There were 9 and 1 3 patients lost to follow-up in the intrafascial group and interfascial group,respectively.The intrafascial technique provided earlier recovery of urinary conti-nence than the interfascial technique at 3 and 6 months after the operation.Similar results in terms of urinary continence were found in both groups at 1 2 months.The erectile function was better in younger patients(age ≤6 5 years)and patients in intrafas-cial group at 6 and 1 2 months after the operation.Biochemical progression-free survival rates were similar in both groups 2 years after the operation.Conclusion Under strict indications,the intrafascial technique provides similar operative outcomes and short-term oncological results to the interfascial nerve-sparing technique,but quicker recovery of urinary continence and bet-ter erectile function.The intrafascial nerve-sparing technique is preferred for young PCa patients who are at clinical stages cT1 to cT2 a and have normal erectile function before operation.