中文摘要：

目的：探索筋膜内保留神经的腹膜外途径腹腔镜下根治性前列腺切除术（intrafascial nerve-sparing endoscopic extraperitoneal radical prostatectomy,nsEERPE）治疗大体积前列腺癌的手术技巧、控瘤效果和患者术后控尿及勃起功能恢复情况。方法：回顾性分析2012年1月~2016年6月我院71例前列腺体积〉75ml且行nsEERPE术的低危局限性前列腺癌患者的临床资料,中位年龄[M（Q_R）]66（62~71）岁,中位PSA值7.1（5.2~8.8）μg/L。所有手术均由同一术者主刀,关键技术改良包括保留较小膀胱颈及处理增大的中叶、侧入路逆行保留神经血管束和膀胱颈整形。术后定期监测PSA水平及随访临床信息,通过调查问卷评估记录患者术前、术后3、6、12个月时的控尿及勃起功能。结果：所有手术均顺利完成,中位手术时间215（182~240）min、出血量400（300~600）ml、住院时间13（12~16）d、留置尿管时间9（8~12）d。术中未出现严重并发症,切缘阳性率为7.0%（5/71）。术后3、6、12个月时控尿率分别为63.4%、85.9%和95.8%;勃起功能恢复率分别为42.9%、59.5%和73.8%。中位随访时间37（24~49）个月内的生化复发率为7.0%（5/71）。结论：改良nsEERPE术治疗大体积低危局限性前列腺癌操作安全,控瘤效果好,患者术后控尿和勃起功能恢复满意。

英文摘要：

Objective：To investigate the surgical modifications as well as functional and oncological outcomes of intrafascial nerve-sparing endoscopic extraperitoneal radical prostatectomy（nsEERPE）with regard to prostate cancer（PCa）patients with large prostate volume.Method：From January 2012 to June 2016,a total of 71 consecutive low-risk PCa patients with prostate volume〉75ml who underwent nsEERPE in our institution were retrospectively analyzed.The median age of patients was[M（QR）]66（range,62-71）years old,and the median prostate-specific antigen（PSA）level was 7.1（range,5.2-8.8）μg/L.All surgeries have been performed by one surgeon and the key points of our surgical modifications included：smaller bladder neck preservation and subsequent management of enlarged median lobe,lateral and retrograde dissection for neurovascular bundle preservation,and bladder neck reconstruction.Clinical data and PSA level were periodically recorded during the postoperative follow-up.Continence and potency outcomes were evaluated with self-administered validated questionnaires at baseline,3,6and 12 months after surgery.Result：All surgeries have been successfully accomplished.The median operative time was 215（range,182-240）minutes,the median blood loss was 400（range,300-600）ml,the median in-hospital stay was 13（range,12-16）days and the median catheterization time was 9（range,8-12）days.No severe perioperative complication occurred and the overall positive surgical margin was 7.0%（5/71）.Continence and potency rates following nsEERPE were 63.4%,85.9%,95.8%and 42.9%,59.5%,73.8%at 3,6,and 12 months of follow-up respectively.Biochemical recurrence rate was 7.0%（5/71）during a median follow-up period of 37（range,24-49）months.Conclusion：The intrafascial nsEERPE with several technical improvements is a safe procedure that provides satisfactory continence,potency and oncological outcomes with respect to PCa patients with large prostate volume.