机器人辅助筋膜内前列腺癌根治术对术后尿控影响的研究  

Urinary function of intrafascial robot-assisted laparoscopic radical prostatectomy

作　　者：施振凯 高旭[1] 王海峰[1] 王燕[1] 施挺[1] 鲁欣[1] 马春飞[1] 朱峰[1] 董振阳[1] 何必鸣 常易凡 侯建国[1] 许传亮[1] 孙颖浩[1] 

机构地区：[1]第二军医大学附属长海医院泌尿外科,上海200433

出　　处：《中华腔镜泌尿外科杂志（电子版）》2016年第1期8-11,共4页Chinese Journal of Endourology(Electronic Edition)

基　　金：国家自然科学基金面上项目(81172076)

摘　　要：目的总结21例行机器人辅助筋膜内前列腺癌根治术的患者资料,探讨该方法对患者术后尿控功能的影响。方法 2012年4月至2014年10月,长海医院单一术者实施机器人辅助的腹腔镜下前列腺癌根治术100例,其中筋膜内前列腺癌根治术21例,21例中4例在前列腺切除术后行盆内筋膜重建。4例患者术前临床分期均低于T2期,平均PSA为11.1 ng/ml。在成功进行双侧筋膜内前列腺切除术后,应用尿道吻合剩余的倒刺线,自尿道吻合位置,将两侧剩余的盆内筋膜缝合,使膀胱颈口在两侧的盆内筋膜的挤压下形成一定长度的功能性尿道。结果患者术中出血量50-600 ml,平均260 ml,术中输血1例,术后14 d拔除导尿管。术后住院天数为6-19 d,平均9 d。术后病理切缘阳性5例,其中4例为尖部阳性,包膜侵犯2例,精囊腺侵犯1例。术后4周血清PSA〉0.2 ng/ml 2例,〈0.2 ng/ml 19例。随访1-22个月,平均随访时间12.4个月。本组21例,术后2周拔管排尿可控6例,术后1个月、3个月尿控有效率（以每天应用尿垫≤1块为标准）分别为61.9%（13/21）和90.5%（19/21）。结论选择肿瘤分期较早的患者,掌握一定的操作技巧,机器人辅助筋膜内前列腺癌根治术可提高患者术后尿控。Objectives To explore the inference of urinary function in men who received intrafascial radical prostatectomy by the 21 patients＇ follow up data. Methods 100 patients underwent robot-assisted laparoscopic radical prostatectomy by one surgeon from April 2012 to October 2014. Among them, there were 21 cases received intrafascial radical prostatectomy and 4 of them plus endopelvic fascia reconstruction. The clinic stages of these 4 cases were all below T2 and the mean PSA was 11.1 ng/ml. The surgical progress as follow： when finished the intrafascial radical prostatectomy, sutured the bladder neck and urethra with 3-0 V-Locs. Then sutured the endopelvic fascia together to form a functional urethra by squeeze the bladder neck. Results Average amount of bleeding was 260 ml（50-600 ml）.1 case had blood transfusion during the surgrey. Removed the catheter on day 14. The mean time of postoperative hospital stay was 9.2 days（6-19 d）. 5 cases had positive surgical margin and 4 of them were apex positive. 2 cases have capsular invasion and 1 case has seminal vesicle invasion. 2 cases with PSA0.2 ng/ml in 4 week after surgery, and the other were below 0. 2 ng/ml. 6 cases could control urination when removed the catheter on day 14. The urinary control rate on 1 month was 61.9%, and 3 month was 90.5%. Conclusions When we choose the early stage patients and use some tricks, intrafascial robot-assisted laparoscopic radical prostatectomy can improve the urinary function.

关 键 词：机器人 前列腺肿瘤 尿失禁 

分 类 号：R737.25[医药卫生—肿瘤] TP242[医药卫生—临床医学]