尿道纤维化对腹腔镜根治性前列腺切除术后尿控的影响  

Effects of urethral fibrosis on urinary control after laparoscopic radical prostatectomy

作　　者：梁迎春 吴宇鹏[1] 蔡海[1] 陈少豪 魏勇[1] 薛学义[1] 郑清水[1] 黄金杯[1] 林云知 许宁[1] Liang Yingchun, Wu Yupeng, Cai Hai, Cheng Shaohao, Wei Yong, Xue Xueyi, Zheng Qingshui, Huang Jinbei, Lin Yunzhi, Xu Ning(Department of Urology, First Affiliated Hospital of Fufian Medical University, Fuzhou 350005, Chin)

机构地区：[1]福建医科大学第一附属医院泌尿外科,福州350005

出　　处：《中华医学杂志》2018年第14期1099-1102,共4页National Medical Journal of China

摘　　要：目的探讨术前尿道纤维化程度是否对腹腔镜根治性前列腺切除术后尿控功能的恢复存在影响。方法回顾性分析203例在2010年1月至2014年1月间由福建医科大学附属第一医院同一名医师完成的腹腔镜根治性前列腺切除术的患者，并且根据其术前磁共振成像（MRI）判断尿道壁和尿道周围组织纤维化程度将患者分为两组，无／轻微纤维化组（≤2级）144例，严重纤维化组（≥3级）59例。比较两组术后1、3、6、12个月尿控情况。结果两组年龄、体重指数（BMI）、查尔森合并症指数（CCI），国际前列腺症状评分表（IPSS）、前列腺体积、术前前列腺特异性抗原（PSA）、神经保留与切除、术后病理Gleason评分、术后病理分期等差异均无统计学意义。手术均顺利完成，术后随访12—24个月，中位随访时间15个月。术后1个月两组尿控情况差异无统计学意义（P〉0．05）。术后3、6和12个月无／轻微组较严重纤维化组尿控情况好（术后3个月，50．0％与28．8％，P=0．005；术后6个月，91．0％与59．3％，P〈0．001；术后12个月，98．6％与88．1％，P=0．003）。结论术前尿道纤维化程度是腹腔镜根治性前列腺切除术后远期尿控恢复的独立预测因素。术前尿道纤维化严重的患者，术后远期尿控较差。Objective To determine the influence of urethral fibrosis on the recovery of urinary continence after laparoscopic radical prostatectomy. Method A retrospective study of 203 patients from January 2010 to January 2014 who were underwent laparoscopic radical prostatectomy for prostate cancer in the First Affiliated Hospital of Fujian Medical University. The patients were divided into 2 groups according to preoperative T2-weighted magnetic resonance imaging of fibrosis status of the urethral wall and periurethral tissue. One hundred and forty-four（ ≤2 grade） and 59 （ ≥3 grade） were classified into the no/mild and severe urethral fibrosis groups respectively. Urinary continence at 1, 3, 6, 12 months after operation were compared between this two groups respectively. Result There was no significant difference in the two groups with respect to age, body mass index （BMI）, Charlson comorbidity index （CCI）, international prostate symptom score （IPSS）, prostate volume, preoperative prostate-specific antigen value, nerve-sparing procedure, postoperative Gleason score and pathological stage. The operation was completed successfully in all cases. With a median follow-up time of 15 months （ranged from 12 to 24 months ）, there was no statistical difference between the two groups in urinary continence at 1 month after operation （ P 〉 0. 05 ）. The incidences of continence in patients with no/mild fibrosis were significantly higher at 3,6,12 months after operation than those with severe fibrosis. （In the no/mild fibrosis group and severe fibrosis group, the continue rate at 3 mouths was 50. 0% vs 28.8% P =0. 005 ; at 6 mouths was 91.0% vs 59. 3% P 〈0. 001 ; at 12 mouths was 98.6% vs 88. 1% P = 0. 003）. Conclusion Preoperative urethral fibrosis could be a significant predictor of recovery of the long-term urinary continence status after laparoscopic radical prostatectomy. Compared with no/mild fibrosis, severe fibrosis had worse long-term continence status.

关 键 词：前列腺癌 尿道纤维化 术后尿控 磁共振成像 

分 类 号：R737.25[医药卫生—肿瘤]