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目的:认识海绵体的神经血管束(neurovascular-bundle,NVB)的解剖结构,探讨保留性神经全膀胱切除术的手术技巧。方法:回顾性分析15例行保留NVB的全膀胱切除术患者的临床资料,对15例患者及伴侣于术前、术后采用勃起功能国际问卷5(IIEF-5)调查评估勃起功能状况。12例行开放性保留NVB的全膀胱切除术,3例行腹腔镜保留NVB的全膀胱切除术;其中保留双侧NVB者12例,保留单侧NVB者3例。结果:15例保留NVB的患者术后60.0%(9/15)可获得满意勃起,IIEF-5评分为(18.3±3.7),ED发生率为40.0%(6/15)。结论:熟悉NVB的解剖结构,可以有效地保护勃起神经,对减少医源性阳痿的发生有重要意义。
Objective: To understand the anatomy of the cavernous neurovascular bundle (NVB) and to explore the surgical techniques of total cystectomy. Methods: The clinical data of 15 patients undergoing total cystectomy with preserved NVB were retrospectively analyzed. Erectile function was assessed in 15 patients and their partners before and after surgery using the International Questionnaire for Erectile Function 5 (IIEF-5). Total cystectomy was performed in 12 patients with open NVB and in 3 patients undergoing laparoscopic cystectomy with NVB. Among them, 12 patients retained bilateral NVB and 3 patients retained unilateral NVB. Results: Fifteen patients with preserved NVB achieved satisfactory erection after 60.0% (9/15) of follow-up. The IIEF-5 score was (18.3 ± 3.7) and ED was 40.0% (6/15). Conclusion: Familiar with the anatomic structure of NVB can effectively protect the erectile nerve and reduce the incidence of iatrogenic impotence.