Radical retropubic prostatectomy with reduced morbidity: an anatomic approach.
Radical retropubic prostatectomy with reduced morbidity: an anatomic approach.
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降低发病率的根治性耻骨后前列腺切除术：一种解剖学方法。
DOI：
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发表时间：
1988
期刊：
影响因子：
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通讯作者：
P. Walsh
中科院分区：
文献类型：
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作者：
P. Walsh
通过提高对前列腺癌外科解剖的了解，前列腺癌根治性耻骨后前列腺癌切除术的发病率已经降低。对背静脉复合体解剖的描述导致了手术技术的改进，减少了失血量，改善了手术暴露。加上硬膜外麻醉和术前自体献血，将同种异体输血的需要限制在2%的患者身上，并将肺血栓等严重围术期并发症的发生率降低到0.3%。盆丛解剖的勾画和神经血管束作为显微海绵状神经的宏观标志的确定，使外科医生在手术时能够做出明智的决定，即是否可以安全地保留神经血管束或广泛切除标本。在前列腺癌的所有手术方法中，首要目标必须是切除所有肿瘤；保存性功能应该是次要考虑的问题。这些考虑在连续320名患者的治疗中得到了解决；74%的男性术后是有效的。49名患者需要广泛切除一根神经血管束；69%的患者是有效的。除了术后性功能的改善，手术后大小便失禁的发生率也降低了。接受根治性前列腺切除术的患者的总医疗费用从8,500美元到9,500美元不等，与外照射相似。
The morbidity of radical retropubic prostatectomy for prostate cancer has been reduced through improved understanding of the surgical anatomy of the prostate. Delineation of the anatomy of the dorsal vein complex has led to modifications in the surgical technique that have reduced blood loss and improved surgical exposure. The addition of epidural anesthesia and presurgical donation of autologous blood has limited the need for the homologous transfusion of blood to 2% of the patients and has reduced the frequency of serious perioperative complications such as pulmonary emboli to 0.3%. Delineation of the anatomy of the pelvic plexus and identification of the neurovascular bundles as the macroscopic landmark of the microscopic cavernous nerves have made it possible for the surgeon to make an informed decision at the time of surgery whether the neurovascular bundles can be preserved safely or excised widely with the specimen. In all surgical approaches to prostate cancer, the primary goal must be excision of all tumor; preservation of sexual function should be of secondary concern. These considerations were addressed in the treatment of 320 consecutive patients; 74% of the men are potent postoperatively. It was necessary to excise one neurovascular bundle widely in 49 patients; 69% are potent. In addition to improvements in postoperative sexual function, the incidence of incontinence following surgery has been reduced. The total medical expenses for patients undergoing radical prostatectomy range from $8,500 to $9,500 and are similar to those for external-beam radiotherapy.(ABSTRACT TRUNCATED AT 250 WORDS)