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目的:探讨经直肠实时超声引导(TRUS)在保留性神经腹腔镜前列腺癌根治术中(LRP)的作用。方法:2004年6月～2007年3月,对12例TNM分期为T1～T2b的前列腺癌患者行经直肠实时超声引导保留性神经LRP。患者平均年龄62.5岁(57～65岁),术前检查PSA为7.4ng/ml(3.3～9.6ng/ml),IIEF评分平均为17.6分(15～22分)。术中采用TRUS监测神经血管束(NVB)的保留情况。9例保留双侧NVB,3例保留单侧NVB。结果:12例手术均获得成功。平均手术时间分别为270min(210～360min),平均出血量290ml(200～600ml),无切缘阳性患者。9例保留双侧NVB和2例保留单侧NVB的患者均在3～6个月后可成功完成性交。1例保留单侧NVB的患者勃起硬度欠佳,需药物辅助才能完成性交。结论:LRP术中结合TRUS可实时监测NVB的分离,避免NVB的损伤,有助于保留患者阴茎勃起功能。TRUS是保留性神经的LRP术的一种非常实用的新技术。
Objective: To investigate the effect of transrectal real-time guided ultrasound (TRUS) in the treatment of residual laparoscopic radical prostatectomy (LRP). Methods: From June 2004 to March 2007, 12 cases of prostate cancer with TNM stage T1 ~ T2b underwent transrectal real-time ultrasound guided retention of nerve LRP. The average age of patients was 62.5 years (57-65 years). Preoperative PSA was 7.4ng / ml (3.3-9.6ng / ml). The mean IIEF score was 17.6 (15-22). Intraoperative TRUS was used to monitor the preservation of neurovascular bundles (NVBs). Nine patients retained bilateral NVB and three retained unilateral NVB. Results: All the 12 surgeries were successful. The average operation time was 270min (210 ~ 360min), the average amount of bleeding 290ml (200 ~ 600ml), no positive margins patients. Nine patients with preserved bilateral NVB and two patients with preserved unilateral NVB achieved successful intercourse after 3 to 6 months. One patient with preserved unilateral NVB had poor erectile stiffness and required medication to complete intercourse. Conclusion: The combination of TRUS with LRP can monitor the NVB separation in real time and avoid the damage of NVB, which helps to preserve the erectile function of patients. TRUS is a very practical new technique for the preservation of nerve LRP surgery.