一、手術方式:
目前針對腹腔鏡根除性攝護腺切除手術,大體上可分為經腹腔(Transperitoneal approach)手術方式及腹腔外(Extraperitoneal approach)手術方式[8,9],其手術方法大致相同,均利用約4-5根腹腔鏡導引管進行手術,唯一差別在於腹腔外手術方式其進行手術空間營造時(Extraperitoneal space creation),不需進入腹腔,也因此在手術過程時,需注意避免將腹膜打破,以減少因腹腔內壓力增加造成手術視野及手術空間減少之可能。針對手術步驟,可大略分成進入膀胱前空間(Entering the space of Ratzius)、控制骨盆腔背部靜脈叢(Control of dorsal venous complex)、膀胱頸切開及辨識雙側儲精囊(Incision of bladder neck and identification of bilateral seminal vesicle)、分離直腸前空間(Dissection of Denovillier’s fascia)、保留雙側神經血管叢(Preservation of bilateral neurovascular bundle)、尿道切開及膀胱尿道吻合(Incision of urethra and vesicourethral anastomosis)等步驟[10]。
四、手術後功能性成果(Functional outcomes)
針對攝護腺癌患者在接受腹腔鏡根除性攝護腺切除手術之後,一般是以手術一年之可禁尿比率(Urine continence rate)及手術後二年之勃起功能恢復比率(Recovery of erectile function status)作為比較標準,由國外報告可知,其手術後一年之可禁尿比率約為43-89%[4,12,16],其手術後二年之勃起功能恢復比率則約為56%[15],由台北市立聯合醫院之資料,其手術後一年之可禁尿比率為97.8%,其手術後二年之勃起功能恢復比率為48%[13],由於手術後勃起功能之恢復與否與是否進行雙側手術神經血管叢保留有相關,因此,仍須更多病患手術結果方可評估其勃起功能與排尿功能相關之結果。
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