术腓肠神经移植修复海绵体神经损伤的作用（附2例报告）

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1、腹腔镜前列腺癌根治术腓肠神经移植修复海绵体神经损伤的作用（附2例报告）高新【摘要】目的　报道腹腔镜前列腺癌根治术中行腓肠神经移植修复海绵体神经损伤的初步经验。方法2例患者术前行经直肠B超引导前列腺穿刺活检证实为前列腺癌，临床分期为T1c和T2b，Gleason评分分别为5分和7分，分别行保留单侧和未保留性神经腹腔镜前列腺癌根治术，取合适长度的腓肠神经行腹腔镜海绵体神经端端吻合。术后给予口服小剂量西地那非及间歇海绵体内注射PGE1等进行性功能康复治疗。采用IIEF5和Rigiscan评估疗效。结果2例手术均

2、获成功，随访12月，1例单侧腓肠神经移植患者有自发性勃起，另1例行双侧移植者有部分勃起。Rigscan测定分别有80%和40%硬度的夜间勃起。结论　腹腔镜腓肠神经移植修复海绵体神经损伤有助于保留患者术后的勃起功能，术后性康复治疗可促进勃起功能恢复。【关键词】前列腺癌根治术；腹腔镜；海绵体神经；腓肠神经移植EffectofinterpositionsuralnervegraftforimpactedcavernousnervousduringlaparoscopicradicalprostatectomyG

3、AOXin.DepartmentofUrology，TheThirdAffiliatedHospitalofSUNYat-senUniversity，Guangzhou，510630China【Abstract】ObjectivesToreportourinitialexperienceswithinterpositionsuralnervegraftingduringlaparoscopicradicalprostatectomy(LRP).MethodsTheneurovascularbundles(

4、NVB)wereextensivelyexcisedinleftsideofpatient1andbothsidesofpatient2.Withthehem-o-loklocatedthestumpofNVB,interpositionsuralnervegraftingwasperformedusing2-3stitchesofeachendwith6-0polypropylene.Postoperativesexualrehabilitationincludedoralsidenafil(25mg/

5、d)aftercatheterremovedandintracavernosalinjectionofPGE1(10-30μg)onceweekly.Patients’potencywasevaluatedwithIIEF-5andNPTtestbyRigiscan.ResultsThesuralnervegraftingduringLRPwasperformedsuccessfullyinbothpatients.Noseriouscomplicationhappened.During12months’

6、follow-up,thepatientwithleftsuralnervegraftreportedspontaneouserectionwithoutanyhelpanderectionrigiditywas70-80%orgreater.Theotherreportedthepeniswasnotpotentenoughtopenetratewithoutoralsidenafilandtheerectionrigiditywas20-40%.ConclusionsInterpositionsura

7、lnervegraftduringLRPistechnicallyfeasibleandbenefitsforpostoperativeerection.Post-operativesexualrehabilitationishelptopromotepotencyrecovery.【Keywords】Radicalprostatectomy;Laparoscopy;Neurovascularbundles;Suralnervegrafting作者单位：510630广州，广州市天河路600号中山大学附属第

8、三医院泌尿外科前列腺癌（prostatecancer，PCa）是欧美男性发病率最高的恶性肿瘤，死亡率仅次于肺癌。近年来，随着人口老龄化比例的上升和饮食结构的改变，我国PCa的发病率呈现明显的上升趋势，国内有研究报告显示上海地区PCa发病率已跃居男性泌尿系肿瘤首位。随着腹腔镜技术的进步，腹腔镜前列腺癌根治术（laparoscopicradicalprostatectomy,LRP)己经成为临床上治疗局限性前列腺癌的有效手段[1]