尿道-膀胱颈免打结缝线双针连续吻合法在腹腔镜前列腺癌根治术中的应用与疗效
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摘要
目的:分析免打结缝线双针连续缝合法在腹腔镜前列腺癌根治术尿道-膀胱颈吻合中的应用、并发症及术后尿控率。方法:回顾性分析2015年1月-2017年4月我院泌尿外科共104例使用免打结缝线行双针连续缝合尿道-膀胱颈吻合的腹腔镜前列腺癌根治术的资料。分析手术时间、吻合时间、导尿管留置时间、引流管留置时间、术后尿控率、尿道狭窄发生率等数据。结果:104例手术均顺利完成,无术中转开放病例,平均手术时间为(90. 80±24. 21)min。平均吻合时间为(16. 30±4. 56)min。术后留置导尿管平均时间为(12. 42±0. 16)d,平均引流管留置时间(3. 13±0. 29)d。共发生术后尿漏4例,尿道狭窄1例。术后3个月基本尿控率为78. 84%,完全尿控率65. 38%,术后6个月基本尿控率为93. 27%,完全尿控率为75. 00%;术后12个月基本尿控率为98. 10%,完全尿控率为91. 35%,永久性尿失禁发生率为0%。结论:在腹腔镜前列腺癌根治术中,免打结缝线双针连续缝合法吻合尿道-膀胱颈操作便捷且缩短吻合时间,术后尿漏、尿道狭窄、尿失禁等并发症的发生率低,尿控率高,是一种值得推广的吻合方式。
Objective: To analyze the application, complications, and postoperative continence rate of double-needle continuous suture in urethrovesical anastomosis(UVA)of laparoscopic radical prostatectomy(LRP).Methods: A retrospective analysis of 104 cases of localized prostate cancer which under-went LRP in our hospital from January 2015 to April 2017 was performed. All cases were treated with double - needle continuous suture with knotless suture. The operative time, anastomosis time,catheter indwelling time, drainage tube indwelling time, postoperative continence rate and incidence of urethral stricture were analyzed.Results: All the 104 cases were successfully operated without open surgery, and the average operation time was(90. 80±24. 21) min. The average anastomosis du-ration was(16. 30±4. 56) min. The average time of indwelling catheter was(12. 42±0. 16) days, and the average length of drainage tube was(3. 13±0. 29) days. There were 4 cases of postoperative urinary leakage and 1 case of urethral stricture. The basic continence rate was 78. 84% and complete con-tinence rate was 65. 38% 3 months after operation, and after 6 months, the rates were 93. 27% and75. 00% respectively. After 12 months, the basic continence rate was 98. 10% and the complete con-tinence rate was 91. 35%. The incidence of permanent incontinence was 0%.Conclusion: In LRP,non-knotting suture with double needle continuous suture is easy to operate and the time of anastomosis is short, the incidences of postoperative urinary leakage, urethral stricture and incontinence, and other complications are low, and the continence rate is high, which is worth promoting.
Objective: To analyze the application, complications, and postoperative continence rate of double-needle continuous suture in urethrovesical anastomosis(UVA)of laparoscopic radical prostatectomy(LRP).Methods: A retrospective analysis of 104 cases of localized prostate cancer which under-went LRP in our hospital from January 2015 to April 2017 was performed. All cases were treated with double - needle continuous suture with knotless suture. The operative time, anastomosis time,catheter indwelling time, drainage tube indwelling time, postoperative continence rate and incidence of urethral stricture were analyzed.Results: All the 104 cases were successfully operated without open surgery, and the average operation time was(90. 80±24. 21) min. The average anastomosis du-ration was(16. 30±4. 56) min. The average time of indwelling catheter was(12. 42±0. 16) days, and the average length of drainage tube was(3. 13±0. 29) days. There were 4 cases of postoperative urinary leakage and 1 case of urethral stricture. The basic continence rate was 78. 84% and complete con-tinence rate was 65. 38% 3 months after operation, and after 6 months, the rates were 93. 27% and75. 00% respectively. After 12 months, the basic continence rate was 98. 10% and the complete con-tinence rate was 91. 35%. The incidence of permanent incontinence was 0%.Conclusion: In LRP,non-knotting suture with double needle continuous suture is easy to operate and the time of anastomosis is short, the incidences of postoperative urinary leakage, urethral stricture and incontinence, and other complications are low, and the continence rate is high, which is worth promoting.
引文
[1]叶定伟,朱耀.中国前列腺癌的流行病学概述和启示[J].中华外科杂志,2015,53(4):249-252.Ye DW, Zhu Y. Epidemiology of prostate cancer in China:an overview and clinical implication[J]. Chinese Journal of Surgery, 2015,53(4):249-252.
[2] Heidenreich A, Bellmunt J, Bolla M, et al. EAU guidelines on prostate cancer. part 1:screening, diagno-sis, and treatment of clinically localised disease[J]. Eu-ropean Urology, 2011,59(1):61-71.
[3] Kowalewski KF, Tapking C, Hetjens S, et al. Inter-rupted versus continuous suturing for vesicourethral anastomosis during radical prostatectomy:protocol for a systematic review and meta-analysis[J]. BMJ Open,2017,7(11):e019823.
[4]张旭,居正华,王超,等.腹腔镜下根治性前列腺切除术膀胱尿道单针连续吻合法[J].中华泌尿外科杂志,2009,30(7):476-479.Zhang X, Ju ZH, Wang C, et al. Single needle running suture method for urethrovesical anastomosis during lap-aroscopic radical prostatectomy[J]. Chinese Journal of Urology, 2009,30(7):476-479.
[5] Van Velthoven RF, Ahlering TE, Peltier A, et al.Technique for laparoscopic running urethrovesical anas-tomosis:the single knot method[J]. Urology, 2003, 61(4):699-702.
[6] Williams SB, Alemozaffar M, Lei Y, et al. Random-ized controlled trial of barbed polyglyconate versus poly-glactin suture for robot-assisted laparoscopic prostatecto-my anastomosis:technique and outcomes[J]. Eur Urol, 2010,58(6):875-881.
[7] Lin YF, Lai SK, Liu QY, et al. Efficacy and safety of barbed suture in minimally invasive radical prostatecto-my:a systematic review and meta-analysis[J]. Kaohsi-ung J Med Sci, 2017,33(3):107-115.
[8] Ma LL, Ye JF, Tang WH. Knotless laparoscopic radi-cal prostatectomy:a preliminary experience[J]. Chin Med J(Engl), 2015,128(3):409-412.
[9] Ye XJ, Xiong LL, Liu SJ, et al. Comparison of two kinds of methods for urethrovesical anastomosis during laparoscopic radical prostatectomy[J]. Transl Androl Urol, 2015,4(Suppl 1):AB086.
[10] Ball AJ, Bordeau KP, Davis JW, et al. Modified run-ning vesicourethral anastomosis after robotically assist-ed laparoscopic radical prostatectomy:use of solitary Lapra-Ty to secure posterior approximation[J]. Urolo-gy, 2005,66(1):16-18.
[11] Yasui T, Itoh Y, Maruyama T, et al. The single-knot method with Lapra-Ty clips is useful for training sur-geons in vesicourethral anastomosis during laparoscopic radical prostatectomy[J]. Int Urol Nephrol, 2009,41(2):281-285.
[12] Tyritzis SI, Katafigiotis I, Constantinides CA. All you need to know about urethrovesical anastomotic urinary leakage following radical prostatectomy[J]. J Urol,2012,188(2):369-376.
[13] Mochtar CA, Kauer PC, Laguna MP, et al. Urinary leakage after laparoscopic radical prostatectomy:a sys-tematic review[J]. J Endourol, 2007, 21(11):1 371-1 380.
[14] Hakimi AA, Faleck DM, Sobey S, et al. Assessment of complication and functional outcome reporting in the minimally invasive prostatectomy literature from 2006to the present[J]. BJU Int, 2012,109(1):26-30
[15] Dalton DP, Schaeffer AJ, Garnett JE, et al. Radio-graphic assessment of the vesicourethral anastomosis di-recting early decatheterization following nerve-sparing radical retropubic prostatectomy[J]. J Urol, 1989, 141(1):79-81.
[16]张翀宇,何舜发,甄立雄,等.不同缝合方式对前列腺癌根治术后膀胱尿道吻合口狭窄发生率的影响[J].临床泌尿外科杂志,2013,28(7):517-519.Zhang CY, He SF, Zhen LX, et al. The influence of different suture techniques to the anastomotic stricture incidence rate after radical prostatectomy[J]. Journal of Clinical Urology, 2013,28(7):517-519.
[17] Surya BV, Provet J, Johanson KE, et al. Anastomotic strictures following radical prostatectomy:risk factors and management[J]. J Urol, 1990, 143(4):755-758.
[18] Shimizu T, Takahashi A, Ichihara K, et al. Anasto-motic stricture following radical retropubic prostatecto-my:insights into incidence, management and factors predisposing for occurrence[J]. Nihon Hinyokika Gak-kai Zasshi, 2012,103(4):604-609.
[19] Ouzaid I, Xylinas E, Ploussard G, et al. Anastomotic stricture after minimally invasive radical prostatectomy:what should be expected from the Van Velthoven single-knot running suture[J]? J Endourol, 2012, 26(8):1 020-1 025.
[20] Albisinni S, Aoun F, Peltier A, et al. The single-knot running vesicourethral anastomosis after minimally inva-sive prostatectomy:review of the technique and its mod-ifications, tips, and pitfalls[J]. Prostate Cancer, 2016,2016:1-5.
[21] Kostakopoulos A, Argiropoulos V, Protogerou V, et al. Vesicourethral anastomotic strictures after radical retropubic prostatectomy:the experience of a single in-stitution[J]. Urol Int, 2004,72(1):17-20.
[22] Jacobsen A, Berg KD, Iversen P, et al. Anastomotic complications after robot-assisted laparoscopic and open radical prostatectomy[J]. Scand J Urol, 2016,50(4):274-279.
[23] Mottet N, Bellmunt J, Bolla M, et al. EAU-ESTRO-SIOG guidelines on prostate cancer. part 1:screening,diagnosis, and local treatment with curative intent[J].Eur Urol, 2017,71(4):618-629.
[24] Schlomm T, Heinzer H, Steuber T, et al. Full func-tional-length urethral sphincter preservation during radi-cal prostatectomy[J]. Eur Urol, 2011,60(2):320-329.
[25] Van Randenborgh H, Paul R, Kubler H, et al. Im-proved urinary continence after radical retropubic prosta-tectomy with preparation of a long, partially intrapros-tatic portion of the membraneous urethra:an analysis of1013 consecutive cases[J]. Prostate Cancer Prostatic Dis, 2004,7(3):253-257.
[26] Rocco F, Carmignani L, Acquati P, et al. Restoration of posterior aspect of rhabdosphincter shortens conti-nence time after radical retropubic prostatectomy[J]. J Urol, 2006,175(6):2 201-2 206.
[27] Freire MP, Weinberg AC, Lei Y, et al. Anatomic bladder neck preservation during robotic-assisted laparo-scopic radical prostatectomy:description of technique and outcomes[J]. Eur Urol, 2009,56(6):972-980.
[28]任建,王翔,刘乃波,等.保留膀胱颈联合尿道横纹括约肌重建对腹腔镜前列腺癌根治术后尿控的影响[J].中华医学杂志,2014,(14):1 045-1 047.Ren J, Wang X, Liu NB, et al. Effects of bladder neck preservation and reconstruction of rhabdosphincter on urinary continence recovery after laparoscopic radical prostatectomy[J]. National Medical Journal of China,2014,(14):1 045-1 047.
[29] Canvasser NE, Lay AH, Koseoglu E, et al. Posterior urethral suspension during robot-assisted radical prosta-tectomy improves early urinary control:a prospective cohort study[J]. J Endourol, 2016,30(10):1 089-1 094.
[30] Patel VR, Coelho RF, Palmer KJ, et al. Periurethral suspension stitch during robot-assisted laparoscopic radi-cal prostatectomy:description of the technique and con-tinence outcomes[J]. Eur Urol, 2009,56(3):472-478.
[31] Matsuyama H, Matsumoto H, Nagao K, et al. Run-ning suture versus interrupted suture for vesicourethral anastomosis in retropubic radical prostatectomy:a ran-domized study[J]. Int J Urol, 2015,22(3):271-277.
[2] Heidenreich A, Bellmunt J, Bolla M, et al. EAU guidelines on prostate cancer. part 1:screening, diagno-sis, and treatment of clinically localised disease[J]. Eu-ropean Urology, 2011,59(1):61-71.
[3] Kowalewski KF, Tapking C, Hetjens S, et al. Inter-rupted versus continuous suturing for vesicourethral anastomosis during radical prostatectomy:protocol for a systematic review and meta-analysis[J]. BMJ Open,2017,7(11):e019823.
[4]张旭,居正华,王超,等.腹腔镜下根治性前列腺切除术膀胱尿道单针连续吻合法[J].中华泌尿外科杂志,2009,30(7):476-479.Zhang X, Ju ZH, Wang C, et al. Single needle running suture method for urethrovesical anastomosis during lap-aroscopic radical prostatectomy[J]. Chinese Journal of Urology, 2009,30(7):476-479.
[5] Van Velthoven RF, Ahlering TE, Peltier A, et al.Technique for laparoscopic running urethrovesical anas-tomosis:the single knot method[J]. Urology, 2003, 61(4):699-702.
[6] Williams SB, Alemozaffar M, Lei Y, et al. Random-ized controlled trial of barbed polyglyconate versus poly-glactin suture for robot-assisted laparoscopic prostatecto-my anastomosis:technique and outcomes[J]. Eur Urol, 2010,58(6):875-881.
[7] Lin YF, Lai SK, Liu QY, et al. Efficacy and safety of barbed suture in minimally invasive radical prostatecto-my:a systematic review and meta-analysis[J]. Kaohsi-ung J Med Sci, 2017,33(3):107-115.
[8] Ma LL, Ye JF, Tang WH. Knotless laparoscopic radi-cal prostatectomy:a preliminary experience[J]. Chin Med J(Engl), 2015,128(3):409-412.
[9] Ye XJ, Xiong LL, Liu SJ, et al. Comparison of two kinds of methods for urethrovesical anastomosis during laparoscopic radical prostatectomy[J]. Transl Androl Urol, 2015,4(Suppl 1):AB086.
[10] Ball AJ, Bordeau KP, Davis JW, et al. Modified run-ning vesicourethral anastomosis after robotically assist-ed laparoscopic radical prostatectomy:use of solitary Lapra-Ty to secure posterior approximation[J]. Urolo-gy, 2005,66(1):16-18.
[11] Yasui T, Itoh Y, Maruyama T, et al. The single-knot method with Lapra-Ty clips is useful for training sur-geons in vesicourethral anastomosis during laparoscopic radical prostatectomy[J]. Int Urol Nephrol, 2009,41(2):281-285.
[12] Tyritzis SI, Katafigiotis I, Constantinides CA. All you need to know about urethrovesical anastomotic urinary leakage following radical prostatectomy[J]. J Urol,2012,188(2):369-376.
[13] Mochtar CA, Kauer PC, Laguna MP, et al. Urinary leakage after laparoscopic radical prostatectomy:a sys-tematic review[J]. J Endourol, 2007, 21(11):1 371-1 380.
[14] Hakimi AA, Faleck DM, Sobey S, et al. Assessment of complication and functional outcome reporting in the minimally invasive prostatectomy literature from 2006to the present[J]. BJU Int, 2012,109(1):26-30
[15] Dalton DP, Schaeffer AJ, Garnett JE, et al. Radio-graphic assessment of the vesicourethral anastomosis di-recting early decatheterization following nerve-sparing radical retropubic prostatectomy[J]. J Urol, 1989, 141(1):79-81.
[16]张翀宇,何舜发,甄立雄,等.不同缝合方式对前列腺癌根治术后膀胱尿道吻合口狭窄发生率的影响[J].临床泌尿外科杂志,2013,28(7):517-519.Zhang CY, He SF, Zhen LX, et al. The influence of different suture techniques to the anastomotic stricture incidence rate after radical prostatectomy[J]. Journal of Clinical Urology, 2013,28(7):517-519.
[17] Surya BV, Provet J, Johanson KE, et al. Anastomotic strictures following radical prostatectomy:risk factors and management[J]. J Urol, 1990, 143(4):755-758.
[18] Shimizu T, Takahashi A, Ichihara K, et al. Anasto-motic stricture following radical retropubic prostatecto-my:insights into incidence, management and factors predisposing for occurrence[J]. Nihon Hinyokika Gak-kai Zasshi, 2012,103(4):604-609.
[19] Ouzaid I, Xylinas E, Ploussard G, et al. Anastomotic stricture after minimally invasive radical prostatectomy:what should be expected from the Van Velthoven single-knot running suture[J]? J Endourol, 2012, 26(8):1 020-1 025.
[20] Albisinni S, Aoun F, Peltier A, et al. The single-knot running vesicourethral anastomosis after minimally inva-sive prostatectomy:review of the technique and its mod-ifications, tips, and pitfalls[J]. Prostate Cancer, 2016,2016:1-5.
[21] Kostakopoulos A, Argiropoulos V, Protogerou V, et al. Vesicourethral anastomotic strictures after radical retropubic prostatectomy:the experience of a single in-stitution[J]. Urol Int, 2004,72(1):17-20.
[22] Jacobsen A, Berg KD, Iversen P, et al. Anastomotic complications after robot-assisted laparoscopic and open radical prostatectomy[J]. Scand J Urol, 2016,50(4):274-279.
[23] Mottet N, Bellmunt J, Bolla M, et al. EAU-ESTRO-SIOG guidelines on prostate cancer. part 1:screening,diagnosis, and local treatment with curative intent[J].Eur Urol, 2017,71(4):618-629.
[24] Schlomm T, Heinzer H, Steuber T, et al. Full func-tional-length urethral sphincter preservation during radi-cal prostatectomy[J]. Eur Urol, 2011,60(2):320-329.
[25] Van Randenborgh H, Paul R, Kubler H, et al. Im-proved urinary continence after radical retropubic prosta-tectomy with preparation of a long, partially intrapros-tatic portion of the membraneous urethra:an analysis of1013 consecutive cases[J]. Prostate Cancer Prostatic Dis, 2004,7(3):253-257.
[26] Rocco F, Carmignani L, Acquati P, et al. Restoration of posterior aspect of rhabdosphincter shortens conti-nence time after radical retropubic prostatectomy[J]. J Urol, 2006,175(6):2 201-2 206.
[27] Freire MP, Weinberg AC, Lei Y, et al. Anatomic bladder neck preservation during robotic-assisted laparo-scopic radical prostatectomy:description of technique and outcomes[J]. Eur Urol, 2009,56(6):972-980.
[28]任建,王翔,刘乃波,等.保留膀胱颈联合尿道横纹括约肌重建对腹腔镜前列腺癌根治术后尿控的影响[J].中华医学杂志,2014,(14):1 045-1 047.Ren J, Wang X, Liu NB, et al. Effects of bladder neck preservation and reconstruction of rhabdosphincter on urinary continence recovery after laparoscopic radical prostatectomy[J]. National Medical Journal of China,2014,(14):1 045-1 047.
[29] Canvasser NE, Lay AH, Koseoglu E, et al. Posterior urethral suspension during robot-assisted radical prosta-tectomy improves early urinary control:a prospective cohort study[J]. J Endourol, 2016,30(10):1 089-1 094.
[30] Patel VR, Coelho RF, Palmer KJ, et al. Periurethral suspension stitch during robot-assisted laparoscopic radi-cal prostatectomy:description of the technique and con-tinence outcomes[J]. Eur Urol, 2009,56(3):472-478.
[31] Matsuyama H, Matsumoto H, Nagao K, et al. Run-ning suture versus interrupted suture for vesicourethral anastomosis in retropubic radical prostatectomy:a ran-domized study[J]. Int J Urol, 2015,22(3):271-277.
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