保留膀胱颈近端尿道在前列腺癌根治术后尿控功能中的作用
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摘要
目的探讨腹腔镜前列腺癌根治术中保留膀胱颈近端尿道的手术技巧、可行性及对术后尿控功能的作用。方法收集我院2015年8月—2017年1月行腹膜外腹腔镜前列腺癌根治术患者43例,将其中成功保留膀胱颈近端尿道的患者24例分为观察组,未能保留膀胱颈近端尿道的19例患者为对照组。比较两组手术时间、出血量、手术切缘阳性率,使用国际尿控协会调查问卷评估比较拔除尿管后即刻、1个月、3个月时尿控率。结果 43例手术均顺利完成,未出现明显并发症,观察组与对照组手术时间、术中出血量、手术切缘阳性率、住院时间比较无明显差异[(123.64±23.45)min比(117.52±32.47)min、(110.35±98.77)mL比(131.43±78.35)mL、8.33%比5.26%、(4.25±2.32)天比(5.36±2.15)天,P均>0.05]。保留膀胱颈近端尿道组在术后拔除尿管后即刻、术后1、3个月尿控功能恢复率显著高于对照组[79.17%(19/24)比42.11%(8/19)、87.50%(21/24)比68.42%(13/19)、95.83%(23/24)比78.95%(15/19),P均<0.05]。结论腹腔镜前列腺癌根治术中保留膀胱颈近端尿道安全可行,对术后尿控功能的早期恢复具有促进作用。
Objective To investigate the surgical techniques, feasibility and postoperative urinary control function in preserving the proximal urethra of the bladder neck during laparoscopic radical prostatectomy. Methods Fourtythree patients with prostate cancer were enrolled in our hospital from August 2015 to January 2017, twenty-four patients successfully preserved the proximal urethra of the bladder neck were enrolled as observation group and nineteen patients who failed to retain the proximal urethra of bladder neck as control group. Comparing the two groups in the operation time, intraoperative blood loss, the positive rate of surgical margins, assessment of the urine control function immediately after removal of the catheter, and at 1, 3 months. Results All the operations were successful without significant complications. There were no significant differences between operation observation group and control group in operation time, intraoperative blood loss, positive surgical margin and hospitalization time(123.64±23.45 min vs 117.52±32.47 min, 110.35±98.77 mL vs 131.43±78.35 mL, 8.33% vs 5.26%, 4.25±2.32 d vs5.36±2.15 d, all P>0.05). However, the rate of urinary control recovery after surgery was significantly different between two groups in the time of the catheter was removed immediately, the first month and the third month[79.17%(19/24) vs 42.11%(8/19), 87.50%(21/24) vs 68.42%(13/19), 95.83(23/24) vs 78.95(15/19), all P<0.05].Conclusion Bladder neck preservation during laparoscopic radical prostatectomy is feasible and has priority in early urinary continence.
Objective To investigate the surgical techniques, feasibility and postoperative urinary control function in preserving the proximal urethra of the bladder neck during laparoscopic radical prostatectomy. Methods Fourtythree patients with prostate cancer were enrolled in our hospital from August 2015 to January 2017, twenty-four patients successfully preserved the proximal urethra of the bladder neck were enrolled as observation group and nineteen patients who failed to retain the proximal urethra of bladder neck as control group. Comparing the two groups in the operation time, intraoperative blood loss, the positive rate of surgical margins, assessment of the urine control function immediately after removal of the catheter, and at 1, 3 months. Results All the operations were successful without significant complications. There were no significant differences between operation observation group and control group in operation time, intraoperative blood loss, positive surgical margin and hospitalization time(123.64±23.45 min vs 117.52±32.47 min, 110.35±98.77 mL vs 131.43±78.35 mL, 8.33% vs 5.26%, 4.25±2.32 d vs5.36±2.15 d, all P>0.05). However, the rate of urinary control recovery after surgery was significantly different between two groups in the time of the catheter was removed immediately, the first month and the third month[79.17%(19/24) vs 42.11%(8/19), 87.50%(21/24) vs 68.42%(13/19), 95.83(23/24) vs 78.95(15/19), all P<0.05].Conclusion Bladder neck preservation during laparoscopic radical prostatectomy is feasible and has priority in early urinary continence.
引文
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[11]Asimakopoulos AD,Mugnier C,Hoepffner JL,et al.Bladder neck preservation during minimally invasive radical prostatectomy:a standardised technique using a lateral approach[J].Bju International,2012,110(10):1566
[12]Nyarangi-Dix JN,Radtke JP,Hadaschik B,et al.Impact of complete bladder neck preservation on urinary continence,quality of life and surgical margins after radical prostatectomy:a randomized,controlled,single blind trial[J].Journal of Urology,2013,189(3):891-898.
[13]Stolzenburg JU,Kallidonis P.Effect of bladder neck preservation during endoscopic extraperitoneal radical prostatectomy on urinary continence[J].Urologia Internationalis,2010,85(2):135-138.
[2]Silva LA,Andriolo RB,Atallah N.Surgery for stress urinary incontinence due to presumed sphincter deficiency after prostate surgery[J].John Wiley&Sons,Ltd,2013,4(4):CD008306.
[3]麦智鹏,严维刚,陈健,等.前列腺癌根治术后压力性尿失禁的发展规律[J].基础医学与临床,2014,34(10):1397-1400
[4]Touijer K,Eastham JA,Secin FP.Comprehensive prospective comparative analysis of outcomes between open and laparoscopic radical prostatectomy conducted in the years 2003 to2005[J].Journal of Urology,2008,179(5):1811.
[5]Rassweiler J,Hruza M,Teber D.Laparoscopic and robotic assisted radical prostatectomy--critical analysis of the results[J].European Urology,2006,49(4):612.
[6]Eastham JA,Kattan MW,Rogers E,et al.Risk factors for urinary incontinence after radical prostatectomy[J].Journal of Urology,1996,156(5):1724.
[7]张帆,马潞林,黄毅,等.腹腔镜前列腺癌根治术后控尿功能恢复与术前膜性尿道长度的相关性研究[J].中华泌尿外科杂志,2013,34(1):41-44.
[8]Klein EA.Early continence after radical prostatectomy[J].Journal of Urology,1992,148(1):92-5.
[9]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):1045-1047.
[10]Kessler TM,Burkhard FC,Studer UE.Nerve-sparing open radical retropubic prostatectomy[J].European Urology,2007,51(1):90.
[11]Asimakopoulos AD,Mugnier C,Hoepffner JL,et al.Bladder neck preservation during minimally invasive radical prostatectomy:a standardised technique using a lateral approach[J].Bju International,2012,110(10):1566
[12]Nyarangi-Dix JN,Radtke JP,Hadaschik B,et al.Impact of complete bladder neck preservation on urinary continence,quality of life and surgical margins after radical prostatectomy:a randomized,controlled,single blind trial[J].Journal of Urology,2013,189(3):891-898.
[13]Stolzenburg JU,Kallidonis P.Effect of bladder neck preservation during endoscopic extraperitoneal radical prostatectomy on urinary continence[J].Urologia Internationalis,2010,85(2):135-138.