神経保存的前立腺全摘術の手術成績

Abstract

1)神経保存的前立腺全摘術を18例に施行した.患者の年齢は60～80歳, 平均70.8歳であった.2)平均手術時間は2時間53分, 術中平均出血量は802 gであり, 11例は輸血を必要としなかった.3)術後6例に勃起機能の回復がみられ, うち4例が70歳未満の症例であった.回復までの平均期間は9ヵ月であった.4)勃起機能回復者6例のうち4例は, 病変が前立腺に限局していた.5)術後, 極く軽度の腹圧性尿失禁が4例にみられたが, 他はcontinentであった

A total of 18 patients underwent nerve-sparing radical prostatectomy for clinical stage B1 or B2 prostatic cancer. An operation was performed according to the modified technique originally described by Walsh and associates. The operative technique involved three steps: 1) accurate ligation of dorsal vein complex, which makes a relatively bloodless field and makes it possible to dissect the lateral pelvic fascia from the prostate; 2) the incision in the lateral pelvic fascia is made anterior to the neurovascular bundle; 3) the lateral pedicle is divided close to the prostate. There were no major intraoperative complications such as rectal perforation or ureteral injury. The mean blood loss was 802 g (340-1600 g) and the average duration of surgery was 173 minutes. Eleven patients had no blood transfusions. Postoperatively, there was a wound infection in one case. Mild bladder neck contracture in one case responded to single dilatation. Sexual function was evaluated in 16 of the patients who have been followed for more than three months and who had not received hormone therapy postoperatively. Of 16 patients 6 (37%) had return of erectile function. Return of erections required 3-15 months (average 9 months). Patients under 70 years old had a higher incidence (80%) of return of erections than those over 70 years old. Four of the 6 patients had tumor involvement confined to the prostate. Initially most patients had significant amounts of stress incontinence. This resolved within the first or second postoperative month. Finally 4 had slight stress urinary incontinence but no patients had total incontinence. The results suggest that nerve-sparing radical prostatectomy is an anatomically safe approach. It can contribute to the quality of life in men at a stage when it is still curable.