腹膜外腔镜下根治性前列腺切除术中保留膀胱颈对术后早期控尿功能恢复的影响  

Effect of bladder neck preservation on urinary continence in endoscopic extraperitoneal radical pros-tatectomy

作　　者：李恭会[1] 朱世斌[1] 成晟[1] 汪强[1] 俞世成[1] 葛光炬[1] 陈彼得[1] 余大敏[1] 张志根[1] 

机构地区：[1]浙江大学医学院附属邵逸夫医院泌尿外科,杭州310016

出　　处：《中华泌尿外科杂志》2013年第5期361-365,共5页Chinese Journal of Urology

基　　金：国家自然科学基金（30973001）;钱江人才计划（201iRl0039）

摘　　要：目的探讨腹膜外腹腔镜下根治性前列腺切除术（extraperitoneal endoscopic radica lprostatectomy，EERP）中保留膀胱颈的可行性、有效性和安全性，着重探讨保留膀胱颈对术后早期控尿功能恢复的影响。方法回顾性分析2009年6月至2012年12月34例保留膀胱颈的EERP患者和38例未保留膀胱颈EERP患者的术前资料、手术时间、术中出血量、术后病理分期、手术切缘阳性率、早期控尿等临床资料。依据国家癌病组织不良事件通用毒性评分量表对尿失禁进行分级。0级：无明显尿失禁；1级：腹内压陡然升高，如用力咳嗽、大笑、喷嚏时，出现尿失禁；2级：尿失禁部分受控，如起立、坐下或行走时，出现尿失禁；3级：尿失禁不受控，出现与体位、活动无关。利用日尿垫用量评估患者术后控尿情况。0～1片／d为控尿基本正常，2—3片／d为轻度尿失禁，〉3片／d为重度尿失禁。结果两组患者的年龄、体质指数、前列腺体积、术前血清PSA水平、术前Gleason评分等比较差异均无统计学意义（P〉0．05）。两组手术时间、术中出血量、术后留置尿管时间、术后住院时间、术后血清PSA水平等比较差异均无统计学意义（P〉0．05）。保留膀胱颈组和未保留膀胱颈组各有4例术后手术切缘阳性。保留膀胱颈组术后漏尿2例，未保留膀胱颈组6例。保留膀胱颈患者拔除尿管当日以及1周、1个月、3个月时尿失禁0级例数分别为3例（8．8％）、9例（26．5％）、16例（47．1％）、24例（70．6％），控尿基本正常者分别为7例（20．6％）、12例（35．3％）、22例（64．7％）、28例（82．4％）；未保留膀胱颈患者拔除尿管当日以及1周、1个月、3个月时尿失禁0级例数分别为1例（2．6％）、2例（5．3％）、5例（13．2％）、13例（34．2％），控尿基本正常者分别为2例（5．3％）、5例（13．2％）、10例（26．3Objective To assess the feasibility, efficacy and safety of bladder neck preservation （BNP） in endoscopic extraperitoneal radical prostatectomy （EERP）, and evaluate the influence on postop- erative early continence. Methods Preoperative data, operative time, blood lose, pathological staging, margin status and early continence status from 34 BNP and 38 standard technique （ST） in EERP were retro- spectively assessed. Urinary incontinence was evaluated based on the NCI Common Toxicity Criteria （version 2）. Grade 0 is defined as no incontinence; Grade 1 incontinence occurs with coughing, sneezing, or laugh- ing; Grade 2 is spontaneous incontinence with some control; and Grade 3 is no control Number of dailypads usage were also used to measure urinary incontinence. 0 - 1 pad/day was defined as urinary conti- nence, 2 -3 pads/day was defined as mild incontinence, 〉 3 pads/day was defined as incontinence. Results Both groups were similar in age, body mass index, prostate volume, prostate-specific antigen and Gleason score （P 〉 0.05）. There was no significant difference in operative time, blood loss, catheter re- moval time, postoperative hospital stay, and postoperative PSA levels （ P 〉 0.05）. There were 4 cases of positive margin in BNP and ST groups respectively. There were 2 cases of urine leakage in BNP group, and 6 in ST group. The cases of grade 0 in BNP group in first day, 1 week, 1 month and 3 months after catheter removal were3 （8.8%）, 9 （26.5%）, 16 （47.1%）, 24 （70.6%）. The cases of 0-1 pad/day were7 （20.6%）, 12 （35.3%）, 22 （64.7%）, 28 （82.4%）, respectively. The cases of grade 0 in ST group in first day, 1 week, 1 month and 3 months after catheter removal were 1 （2.6%） , 2 （5.3%） , 5 （ 13.2% ） , 13 （34.2%）. The cases of 0-1 pad/day were2 （5.3%）, 5 （13.2%）, 10 （26.3%）, 20 （52.6%）, respectively. There were significant differences in postoperative early continence between BNP and ST groups （P 〈 0.05）. Conclusion EER

关 键 词：前列腺肿瘤 前列腺切除术 腹腔镜 保留膀胱颈 控尿 

分 类 号：R737.25[医药卫生—肿瘤]