保留“堤坝式”前列腺腹侧筋膜对膀胱癌根治术后患者勃起功能的影响

中国临床解剖学杂志 ›› 2013, Vol. 31 ›› Issue (3): 342-345.

保留“堤坝式”前列腺腹侧筋膜对膀胱癌根治术后患者勃起功能的影响

雒向宁^1,2，　陈凌武²，　陈俊星²，　林焕懿²，　邓楠²

1.陕西中医学院附属医院泌尿外科，陕西咸阳 712000；　2.中山大学附属第一医院泌尿外科, 广州 510080

收稿日期:2013-01-15 出版日期:2013-05-25 发布日期:2013-06-06
通讯作者: 陈凌武，教授，主任医师，博士生导师，E-mail:chengling　wu@hotmail.com E-mail:yalxn@hotmail.com
作者简介:雒向宁（1979-）男，主治医师，讲师，博士，研究方向：保留勃起神经的男性盆腔肿瘤手术改良与创新， Tel:18089172600

Values of "dam-sparing" of Prostatic Ventral Fascia in Radical Cystectomy and Effect on Erectile Function in Patients Postoperatively

LUO Xiang-ning ^1,2, CHEN Ling-wu², CHEN Jun-xing², LIN Huan-yi², DENG Nan²

1.Department of Urology, The Affiliated Hospital of Shaanxi TCM College, Xianyang 712000, China； 2. Department of Urology, The First Affiliated Hospital of SUN Yat-sen University, Guangzhou 510080,China

Received:2013-01-15 Online:2013-05-25 Published:2013-06-06

摘要/Abstract

摘要：

目的　报道保留“堤坝式”前列腺腹侧筋膜在膀胱癌根治术中的应用，及其对患者术后勃起功能的影响。方法　40例浸润性膀胱癌男性患者，术前勃起功能评分≥22分，均接受膀胱癌根治性切除术，其中23例按传统方式保留双侧神经血管束（A组），17例术中采用前列腺腹侧筋膜“堤坝样”保留法联合传统方式保留双侧神经血管束（B组）。术后6个月、12个月分别对患者进行国际勃起功能问卷式评估，比较两组患者术后勃起功能的早期恢复情况。结果　根据男性性健康量表评估结果，术后6个月时：≥17分者，A组与B组分别为17例与15例（（73.9% vs 88.2%,P＜0.05）；≥22分者，A组与B组分别为11例与12例（47.8% vs 70.6%, P＜0.05）。术后12个月时，≥17分者，A组与B组分别为18例与17例（78.3% vs 100%，P＜0.05），≥22分者，A组与B组分别为13例与14例（56.5% vs 82.4%，P＜0.05）。结论　前列腺腹侧筋膜“堤坝样”保留法与保留双侧神经血管束的联合应用，可以显著提高膀胱癌根治术后患者的勃起功能恢复率。

关键词: , 前列腺筋膜, 膀胱癌根治术, 勃起功能

Abstract:

Objective　To study the values of "dam-sparing" of prostatic ventral fascia in radical cystectomy,and the effect on erectile function in patients postoperatively.　Methods　40 male patients of invasive bladder cancer, the scores of Sexual Health Inventory for Men ≥22 in all patients preoperatively.And then received radical cystectomy.23 cases received the traditional operative methods of bilateral neurovascular bundle sparing in radical cystectomy (A group),17 cases received the traditional methods of bilateral neurovascular bundle sparing combined with "dam-sparing" of prostatic ventral fascia in radical cystectomy.Data on postoperative sexual function were collected at 6、12 months, compared the early postoperative erectile functional rehabilitation between the two groups.　Results　Based on the results of Sexual Health Inventory for Men score, at 6 months postoperatively: 17 cases in A group and 15 cases in B group achieved score of 17 or greater（73.9% vs 88.2%,P＜0.05）. 11 cases in A group and 12 cases in B group achieved score of 22 or greater（47.8% vs 70.6%, P＜0.05）. at 12 months postoperatively, 18 cases in A group and 17 cases in B group achieved score of 17 or greater（78.3% vs 100%，P＜0.05）, 11 cases in A group and 12 cases in B group achieved score of 22 or greater（56.5% vs 82.4%，P＜0.05）.　Conclusions　"dam-sparing" of prostatic ventral fascia combined with traditional methods of bilateral neurovascular bundle sparing in radical cystectomy would markedly improve postoperative erectile function in radical cystectomy.

Key words: Prostatic fascia, Radical cystectomy, Erectile function

中图分类号:

R697.3

雒向宁, 陈凌武, 陈俊星, 林焕懿, 邓楠. 保留“堤坝式”前列腺腹侧筋膜对膀胱癌根治术后患者勃起功能的影响[J]. 中国临床解剖学杂志, 2013, 31(3): 342-345.

LUO Xiang-Ning, CHEN Ling-Wu, CHEN Dun-Xing, LIN Huan-Yi, DENG Nan. Values of "dam-sparing" of Prostatic Ventral Fascia in Radical Cystectomy and Effect on Erectile Function in Patients Postoperatively[J]. Chinese Journal Of Clinical Anatomy, 2013, 31(3): 342-345.

参考文献

[1] Nordstr?觟m GM, Nyman CR. Male and female sexual function and activity following ileal conduit urinary diversion
[J]. Br JUrol, 1992,70(1): 33-42.

[2] Cosciani Cunico S, De Luca V, Thaer B, et al. Sex-dynamic characterization of patients subjected to radical pelvic cavity surgery
[J]. Arch Ital Urol Androl, 1994, 66(1):11-14.

[3] 梅骅,陈凌武,高新.泌尿外科手术学
[M]. 第3版, 北京:人民卫生出版社,2008: 250-257.

[4] Parsons JK, Marschke P, Maples P, et al. Effect of methylprednisolone on return of sexual function after nerve-sparing radical retropubic prostatectomy
[J].Urology, 2004,64(5):987-996.

[5] Walsh PC, Donker PJ. Impotence following radical prostatectomy; insight into aetiology and prevention
[J]. J Urol, 1982, 128(3): 492-497.

[6] Walsh PC, Mostwin JL. Radical prostatectomy and cystoprostatectomy with preservation of potency: results using a new nerve-sparing technique
[J]. Br J Urol, 1984,56(4):694-703.

[7] Schilling A, Friesen A. Transprostatic selective cystectomy with an ileal bladder
[J]. Eur Urol, 1990,18(3):253-264.

[8] Spitz A, Stein JP, Lieskovsky G, et al. Orthotopic urinary diversion with preservation of erectile and ejaculatory function in men requiring radical cystectomy for nonurothelial malignancy: a new technique
[J]. J Urol, 1999,161(6):1761-1772.

[9] Guazzom G, Cestari A, Colombo R, et al. Laparoscopic nerve-and seminal-sparing cystectomy with orthotopic ileal neobladder: the first three cases
[J]. Eur Urol, 2003,44 (5): 567-578.

[10] 黄健,黄海,林天歆,等.保留前列腺包膜的膀胱全切除-原位回肠新膀胱术
[J].现代泌尿生殖肿瘤杂志, 2009, 1(1):4-7.

[11]Lane BR, Finelli A, Moinzadeh A, et al. Nerve-sparing laparoscopic radical cystectomy: technique and initial outcomes
[J]. Urology, 2006, 68(4):778-783.

[12]王志华，陈忠. 临床上能否施行保留生育功能的膀胱癌根治术
[J]. 现代泌尿生殖肿瘤杂志, 2009, 1(1):59-60.

[13]Takenaka A, Murakami G, Soga H, et al. Anatomical analysis of the neurovascular bundle supplying penile cavernous tissue to ensure a reliable nerve graft after radical prostatectomy
[J]. J Urol, 2004, 172(3): 1032–1035.

[14]Kiyoshima K, Yokomizo A, Yoshida T, et al. Anatomical features of periprostatic tissue and its surroundings: a histological analysis of 79 radical retropubic prostatectomy specimens
[J]. Jpn J Clin Oncol, 2004, 34(8):463-468.

[15]Lunacek A, Schwentner C, Fritsch H, et al. Anatomical radical retropubic prostatectomy: ‘curtain dissection’ of the neurovascular bundle
[J]. BJU Int, 2005, 95(5): 1226-1231.

[16] Menon M, Shrivastava A, Kaul S, et al. Vattikuti institute prostatectomy: contemporary technique and analysis of results
[J]. Eur Urol, 2007, 51(3):648-658.

[17]Menon M, Shrivastava A, Bhandari M, et al. Vattikuti institute prostatectomy: technical modifications in 2009
[J]. Eur Urol, 2009, 56(1):89-96.

[18]雒向宁, 陈凌武，关伟明. 前列腺周围神经区间量化分析与前列腺癌手术方式改良的关系
[J].中国临床解剖学杂志, 2012,30(2):157-160.