rpmjResearch'n Practical Medicine JournalResearch and Practical Medicine Journal2410-1893"QUASAR", LLC10.17709/2409-2231-2016-3-4-5rpmj-162Research ArticleОбзорыReviewВОДОСТРУЙНАЯ ДИССЕКЦИЯ В ХИРУРГИИ РАКА ПРЕДСТАТЕЛЬНОЙ ЖЕЛЕЗЫ. СОВРЕМЕННОЕ СОСТОЯНИЕ ПРОБЛЕМЫHYDRODISSECTION FOR PRESERVATION OF NEUROVASCULAR BUNDLE DURING RADICAL PROSTATECTOMYhttps://orcid.org/0000-0001-8264-9871ГеворгянГ. С.GevorgyanH. S.

Геворгян Грант Суренович - аспирант  кафедры урологии, онкологии и радиологии ФПК МР РУДН на базе отделения онкоурологии МНИОИ имени П.А. Герцена – филиал ФГБУ «НМИРЦ».

125284, Россия, Москва, 2-й Боткинский проезд, 3; E-mail: gevorgyan.grant@yandex.ru

Hrant S. Gevorgyan - postgraduate  student of the Department of urology, Oncology and radiology of FPC MD RUPF on the base of the Department of Oncourology.

Address: 3, 2nd Botkinskiy proezd, Moscow, 125284, Russia; E-mail: gevorgyan.grant@yandex.ru

gevorgyan.grant@yandex.ruhttps://orcid.org/0000-0002-0792-6012КостинА. А.KostinA. A.

Костин Андрей Александрович - доктор медицинских наук, профессор, заведующий кафедрой урологии, онкологии и радиологии  ФПК МР РУДН, первый заместитель  генерального директора ФГБУ «НМИРЦ» Минздрава  России.

Andrey A. Kostin - MD., Professor, head of department of urology, oncology and radiology of FAS, Medical institute, PFU of Russia, First Deputy General Director NMRRC.

3, 2nd Botkinskiy proezd, Moscow, 125284, Russia

ВоробьёвН. В.VorobyevN. V.

Воробьёв Николай Владимирович - кандидат медицинских наук, руководитель отделения онкоурологии.

125284, Россия, Москва, 2-й Боткинский проезд, 3

Nikolay V. Vorobyev - PhD, head of department of oncourology.

3, 2nd Botkinskiy proezd, Moscow, 125284, Russia

ШегайП. В.ShegaiP. V.

Шегай Пётр Викторович - кандидат медицинских наук, научный сотрудник отделения онкоурологии.

125284, Россия, Москва, 2-й Боткинский проезд, 3, E-mail: dr.shegai@mail.ru

Peter V. Shegai - PhD, Researcher at the Department of oncourology.

3, 2nd Botkinskiy proezd, Moscow, 125284, Russia, E-mail: dr.shegai@mail.ru

dr.shegai@mail.ruМосковский научно-исследовательский онкологический институт имени П.А. Герцена, филиал Национального медицинского исследовательского радиологического центраРоссияP. Hertsen Moscow Oncology Research Institute, Branch of the National Medical Research Radiological CentreRussian Federation201609122016344451Copyright © Геворгян Г.С., Костин А.А., Воробьёв Н.В., Шегай П.В., 20162016Геворгян Г.С., Костин А.А., Воробьёв Н.В., Шегай П.В.Gevorgyan H.S., Kostin A.A., Vorobyev N.V., Shegai P.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rpmj.ru/rpmj/article/view/162

Нервосберегающая радикальная простатэктомия является одной из высокотехнологичных операций в урологии, и задача хирурга состоит не только в удалении опухоли предстательной железы, но и в обеспечении высокого качества жизни пациента. О важности и актуальности данной проблемы свидетельствует тот факт, что именно ей посвящено большинство вопросов, возникающих у больных в беседе с хирургом еще до операции. На современном этапе диагностические методы дают возможность значительно чаще обнаруживать ранний рак предстательной железы, благодаря чему выявление и лечение таких пациентов стало более доступным и позволяет применить данную операцию.

В последнее время представляется актуальным изучение возможностей применения водоструйной диссекции в области урологии, в частности, при нервосберегающей простатэктомии. Сохранение эректильной функции в основном зависит от качества сбережения сосудисто-нервного пучка. Стандартное использование электрокоагуляции сопряжено с возможностью повреждения сосудисто-нервного пучка. При выполнении операции с помощью водоструйной диссекции, благодаря селективному рассечению тканей тонкой струей воды, выполняется мобилизация предстательной железы из ложа. Все это позволяет избежать травмы сосудисто-нервного пучка и дальнейших послеоперационных осложнений. Применение данной методики может позволить хирургу обеспечить более точную мобилизацию предстательной железы, селективное контролируемое пересечение сосудов, направляющихся к предстательной железе от сосудисто-нервного пучка, уменьшить интраоперационную кровопотерю, сохранение удержания мочи, эректильной функции.

В данном литературном обзоре был рассмотрен опыт применения нервосберегающей радикальной простатэктомии с использованием водоструйного диссектора. Оценены интраоперационные параметры использования данной методики.

Однако, учитывая отсутствие масштабных исследований возможностей данной методики при выполнении радикальной нервосберегающей простатэктомии, позволяющих составить комплексное представление о преимуществах этого метода и его влиянии на эректильную функцию и качество мочеиспускания, необходимо дальнейшее изучение этой проблемы у столь сложной категории больных.

Nerve-sparing radical prostatectomy is one of the high-tech operations in urology, and the challenge of the surgeon is not only to remove the prostate tumor, but also to provide a high quality of life. The fact that most questions devoted from patients in a conversation with the surgeon before the operation are devoted to this issue, shows the importance and relevance. At present, the diagnostic methods allow significantly more likely to detect early  prostate cancer, making finding and treatment of these patients more affordable and allows to apply this operation.

Lately, it seems urgent to explore the possibility of water jet dissection in the field of urology, in particular, for nerve-sparing prostatectomy. Preservation of erectile function depends largely on the quality of separating the neurovascular bundle. Standard use of electrocautery is associated with damage to the neurovascular bundle.  When performing operations using water-jet mobilization of prostate the selective dissection of tissue is performed. This avoids injury of neurovascular bundle and further postoperative complications. The use of this technique may allow the surgeon to provide a more accurate mobilization prostate and selectively controlled intersection vessels heading to the prostate from the neurovascular bundle, reduce intraoperative blood loss,  maintaining continence, erectile function.

This literature review is considered by the experience of using nerve-sparing radical prostatectomy using a water-jet dissector, estimated intraoperative parameters using this method.

However, we have the lack of extensive research capabilities of this technique when performing nerve-preserving radical prostatectomy, that does not allow to make a comprehensive presentation on the benefits of this technique and its effects on erectile function and quality of urination, further study of this issue in such a difficult category of patients.

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The authors declare that there are no conflicts of interest present.