保留耻骨前列腺韧带对前列腺癌根治术后尿失禁的预防

目的探讨耻骨后前列腺癌根治术中保留耻骨前列腺韧带及耻骨直肠悬韧带等对术后尿失禁的预防作用。方法从2008年6月到2009年12月对78例耻骨后前列腺癌根治术患者术中保留耻骨前列腺韧带及耻骨直肠悬韧带等的资料进行回顾性分析。所有患者均经直肠B超引导前列腺穿刺活检获得病理学诊断。方法作下腹正中切口，分层切开进入腹膜外及耻骨后间隙。清除耻骨后的脂肪，显露膀胱颈及前列腺表面的血管。在膀胱与盆壁交界处的筋膜腱弓外侧切开盆筋膜壁层，钝性向深面分离，向外推开肛提肌纤维，即可显露盆壁与前列腺前外侧的间隙。在靠近前列腺尖部横行穿过背血管复合体与前列腺间的平面，缝扎或钳夹、结扎、切断背血管复合体即可显露前列腺尖及膜部尿道，保留附着于此处的耻骨前列腺韧带，贴近前列腺切断尿道前壁。结果所有患者顺利康复，术后尿流率正常，6周内有7例轻度尿失禁，无长期尿失禁者。结论在耻骨后前列腺根治术中按正确的解剖层次操作，保留耻骨前列腺韧带有助于减少尿失禁，取得较好的手术效果。

Prophylaxis on urinary continence preservation after radical retropubic prostatectomy by sparing puboprostatic ligament

Objective To study the effects of puboprostatic ligament and puborectalis sling sparing technique on preventing postoperative incontinence of radical retropubic prostatectomy. Methods 78 patients with prostatic cancer from June 2008 to December 2009 in our hospital underwent radical retropubic prostatcctomy. Puboprostatic ligament and puborectalis sling sparing technique were used in all patients. Prostate puncture biopsy were procedure in all patients to determine pathological diagnosis. Surgical procedures： median abdominal incision was performed to remove retropubic fat and reveal bladder neck and superficial vessels of prostate. Parietal pelvic fascia was slit and musculus levator ani was extrapolated. Large size round needle was used to transfix, ligate and cut off dorsal blood vessel. Puboprostatic ligament was spared and urethra close to prostate tip was cut off. Results All patients were recovered smoothly and postoperative urine rate was normal. Slight incontivence was found only in 7 cases within 6 weeks and no one had long time incontivence. Conclusions With correct anatomic manipulation, puboprostatic ligament and puborectalis sling in preservation on radical retropubic prostatectomy will obtain satisfied outcome.