低温下筋膜内前列腺癌根治术对早期控尿及勃起功能的影响

目的：探讨低温下筋膜内前列腺癌根治术对早期控尿及勃起功能的影响。方法：选择穿刺活检证实的早期前列腺癌患者21例，其中有性生活者17例，在25℃生理盐水局部低温处理下行筋膜内前列腺癌根治术。结果：21例手术均顺利完成，出血量2001100（300±95）ml，平均留置尿管8（6～14）天。术后随访6个月，完全控尿18例（85％）；17例术前有性生活的患者中，术后6个月可完成性生活者13例（76％）。结论：局部低温的应用减轻了前列腺癌根治术的创伤性炎症后遗反应；低温下筋膜内前列腺癌根治术对早期控尿与勃起功能的恢复有益。

The Effect of Intrafascial and Hypothermic Extraperitoneal Radical Prostatectomy on Early Continence and Erection

Objective.. To discuss the treatment efficacy of intrafascial and hypothermic extraperitoneal radical prostatectomy in prostate cancer patients. Methods： The operation was performed in 21 focal prostate cancer patients under preemptive local hypothermia with 25℃ saline. Seventeen patients had preoperative potency. The technique was to keep the endopelvic fascia intact under hypothermia. The prostatic fascia was incised anterior medially from the base of the prostate. And the dissection plane was directly on the prostatic capsule. The bilateral and apex prostate fascia were stripped though this plane without injure the neurovascular bundle and external sphincter. All the 21 patients were followed up for 6 months. Results： All operations were accomplished successfully. Hemorrhage was 200-1 100（300±95） ml. Mean catheterization time was 8（range 6-14） d. At 6 months postoperatively, 85%of 21 patients were continent（no need for pads）, 76% of 17 cases who had potency preoperative kept erections sufficient for intercourse with or without the help of PDE5 inhibitors. Conclusions： The intrafascial and hypothermic extraperitoneal radical prostatectomy may have limited trauma to the prostate surrounding fascia, the neurovascular bundles and the external sphincter.