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目的:探讨用先行经尿道前列腺等离子电切,或经尿道前列腺内腺剜剥术,保留部分前列腺被膜的方法,对根治性膀胱切除回肠正位膀胱术进行改良的应用价值。方法:分析2008年1月～2008年10月行该改良术式9例患者的临床资料。先行经尿道前列腺等离子电切或内腺剜剥术,再行膀胱切除,保留部分前列腺被膜,尽量保留背静脉复合体,不过多解剖盆底结构,保留双侧神经血管束及精囊,前列腺被膜腔与“W”回肠膀胱无张力吻合。随访手术效果及生活质量。结果:6例行经尿道前列腺等离子电切,3例行内腺剜剥术,背静脉复合体5例仅缝扎未离断,2例缝扎并离断,2例未予处理。手术时间300～390 min,失血300～1000ml。均为移行细胞癌,残端(-),G_1、G_2各4例,G_31例;T_1N_0M_01例;T_2N_(0-1)M_07例,T_0N_0M_0 1例。1例术后1个月死亡。8例无瘤生存至今12～19个月,最大尿流率平均19.2 ml/s,白日完全尿控6例,不完全尿控2例;夜间尿失禁1例;IIEF-5评分平均16.6。结论:选择合适病例,可试用经尿道前列腺等离子电切或内腺剜剥术,对根治性膀胱切除回肠正位膀胱术进行改良,以保留部分前列腺被膜,利于保护性神经和盆底尿控结构,并降低手术难度。经随访1年余,短期内未发现肿瘤种植转移复发。新膀胱出口无狭窄,勃起功能及尿控功能恢复较好。
Objective: To investigate the value of radical cystectomy with ileal anteroposterior bladder surgery by means of transurethral resection of prostatic plasma, transurethral prostatic gland stripping, and preservation of part of the prostate capsule. Methods: From January 2008 to October 2008, the clinical data of 9 patients with this modified operation were analyzed. First transurethral resection of prostate plasma or endometriosis, cystectomy, to retain some of the prostate capsule, try to retain the dorsal vein complex, but more anatomical pelvic floor structure, retaining the bilateral neurovascular bundles and seminal vesicles, the prostate capsule And “W ” ileal bladder tension-free match. Follow-up surgical results and quality of life. Results: Transurethral resection of the prostate was performed in 6 cases and dissection in 3 cases. The dorsal venous composite was only sutured and severed in 2 cases, and the other 2 cases were not treated. Surgery time 300 ~ 390 min, blood loss 300 ~ 1000ml. All were transitional cell carcinoma, stump (-), G_1, G_2 in 4 cases, G_31 cases; T_1N_0M_01 cases; T_2N_ (0-1) M_07 cases, T_0N_0M_0 cases. One patient died one month after operation. 8 cases of tumor-free survival 12 months to 19 months, the maximum flow rate of 19.2 ml / s averaged, daytime complete urinary control in 6 cases, incomplete urinary control in 2 cases; night urinary incontinence in 1 case; IIEF-5 score average 16.6. CONCLUSIONS: Choosing the right cases, transurethral resection of the prostate gland or endometriosis can be tried to improve the radical cystectomy of the ileum in order to preserve part of the prostate capsule, which is conducive to the protective nerves and pelvic floor urinary control structures , And reduce the difficulty of surgery. After more than one year of follow-up, no recurrence of tumor metastasis was found in short term. Neo-bladder outlet without stenosis, erectile function and urinary control function recovered better.