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目的总结行前列腺癌根治术的经验和教训,对手术疗效和影响患者生活质量的因素进行分析。方法1993年1月至2005年3月共开展前列腺癌根治手术132例,按照手术的时间,将患者分为早期组(2000年前,34例)和近期组(2001年后,98例),分别统计围手术期各指标情况,对近期组中63例患者的随访结果进行分析;对78例患者的阴茎勃起功能状况进行跟踪调查,其中19例行阴茎夜间生物电阻抗体积测定(NEVA)检查。结果近期组和早期组相比,与手术技术相关的指标逐渐优化。随访的病例中无死于前列腺癌者;以血清前列腺特异抗原(PSA)>0.4μg/L为标准,有9例生化复发。50例在术后6个月内恢复正常排尿,压力性尿失禁8例,完全性尿失禁5例。4例出现膀胱颈部尿道狭窄。56例保留双侧神经患者中,33例(58.9%)恢复勃起功能;22例保留单侧神经患者中,7例(31.8%)恢复勃起功能;19例行NEVA检查者中,动脉供血不足者14例,4例恢复勃起功能;静脉漏者5例,均未恢复勃起功能。结论前列腺癌根治术治疗局限性前列腺癌效果较好。熟悉前列腺解剖,保护血管神经束以及良好的手术技巧,是手术成功的关键,也是影响患者术后生活质量的重要因素。
Objective To summarize the experience and lessons of radical prostatectomy, and to analyze the effect of surgery and the factors affecting the quality of life of patients. Methods A total of 132 cases of radical prostatectomy were performed from January 1993 to March 2005. According to the time of surgery, the patients were divided into the early group (34 cases before 2000) and the recent group (98 cases after 2001) According to the data of perioperative period, the follow-up results of 63 patients in the recent group were analyzed. The penile erectile function of 78 patients was followed up. Among them, 19 patients underwent NEVA examination . Results Compared with the early group, the indexes related to the surgical technique were gradually optimized. There was no death from prostate cancer in the follow-up cases. There were 9 biochemical recurrences with serum PSA> 0.4μg / L as the standard. Fifty patients recovered normal urination within 6 months after operation, 8 cases of stress urinary incontinence and 5 cases of complete urinary incontinence. 4 cases of bladder neck urethral stricture. Of the 56 patients with bilateral neuropathy, erection was restored in 33 (58.9%) patients; erectile function was restored in 7 of 22 (31.8%) of the 22 patients with unilateral neuropathy; in 19 of the NEVA patients, arterial insufficiency 14 cases, 4 cases of erectile function recovery; venous leak in 5 cases, did not restore erectile function. Conclusions Prostatectomy radical prostatectomy is effective in treating localized prostate cancer. Familiar with prostate anatomy, vascular nerve bundle protection and good surgical skills, is the key to the success of surgery, but also affect the quality of life of patients with an important factor.