腹腔镜根治性前列腺切除术中行膀胱颈延长抬高重建及黏膜外翻减张吻合的尿控分析  

The efficacy of urinary continence in patients undergoing radical prostatectomy with bladder neck extension and mucosal eversion reconstruction anastomosis

作　　者：张保[1] 史玉强[1] 高强[1] 杨林[1] 雷振涛[1] Zhang Bao;Shi Yuqiang;Gao Qiang;Yang Lin;Lei Zhentao(Department of Urology, Aerospace Center Hospital, Beijing 100049, China)

机构地区：[1]航天中心医院,北京100049

出　　处：《中华泌尿外科杂志》2019年第8期587-591,共5页Chinese Journal of Urology

摘　　要：目的探讨腹腔镜根治性前列腺切除术中行膀胱颈延长抬高重建及黏膜外翻减张吻合对术后尿控的疗效。方法回顾性分析2016年8月至2018年11月于航天中心医院行腹腔镜根治性前列腺切除术的31例患者的临床资料。年龄62~85岁,平均74.8岁;PSA 6.8~34.2 ng/ml,平均16.5 ng/ml;Gleason评分6~9分,平均7分;前列腺体积44~83 ml,平均61.7 ml。31例术中均行膀胱颈延长抬高重建及黏膜外翻减张吻合,具体方法:腹腔镜下切除前列腺后,在膀胱颈6点位置纵行缝合缩小膀胱颈("网球拍"重建),拉长膀胱颈口至输尿管的距离,缝合2~3针,针距1 cm,再行膀胱颈口黏膜及尿道黏膜外翻,膀胱颈部后壁在中线两侧各间隔1 cm缝合,打结拉紧后即起到折叠膀胱后壁的作用,向后缝合3针,针距1 cm,膀胱颈部即被垫起抬高。然后将膀胱后壁和尿道后壁缝合拉紧,最后吻合膀胱和尿道。观察患者术后尿控恢复情况,分析其临床效果。结果31例手术时间80~210 min,平均139.7 min;术中出血量50~330 ml,平均144.2 ml。31例术中均未中转开放,无大血管及直肠损伤,无吻合口漏尿。术后病理:pT2期21例,pT3期10例;切缘阳性2例(6.45%),其中基底部1例,尖部1例,此2例术后均接受辅助内分泌治疗。31例均于术后10d拔除尿管,17例(54.8%)即刻控尿;7例(22.6%)术后1个月恢复控尿,其中1例术后10 d拔除尿管后出现尿潴留,重新留置尿管2周,拔管后控尿良好;4例(12.9%)术后3个月恢复控尿;3例(9.7%)术后6个月恢复控尿。结论腹腔镜根治性前列腺切除术中行膀胱颈延长抬高及黏膜外翻重建减张吻合,术后早期尿控恢复较好。Objective To discuss the efficacy of urinary continence in patients undergoing radical prostatectomy with bladder neck extension and mucosal eversion reconstruction anastomosis. Methods From August 2016 to November 2018, 31 patients with prostate cancer underwent laparoscopic radical prostatectomy. The patients were 62-85 years old(mean 74.8 years), and the mean PSA score was 16.5 ng/ml(6.8-34.2 ng/ml). The pathological examination confirmed that the Gleason score was 6-9 and the prostate size was 44-83 ml. All patients underwent laparoscopic radical prostatectomy with bladder neck extension and mucosal eversion reconstruction anastomosis. Surgical procedure: After resection of the prostate in laparoscopic radical prostatectomy, the bladder neck was sutured at 6 o'clock position to narrow the bladder neck ("tennis racquet" reconstruction). The interval was 1 cm, and 2-3 needles were sutured, the distance between the neck of the bladder and the ureter was extended. The bladder neck mucosa and urethral mucosa eversion were performed. The posterior wall of the bladder neck was sutured at interval of 1 cm on both sides of the midline. After the knot was tightened, the posterior wall of the bladder was folded and bladder neck was elevated. The posterior wall of the bladder and the posterior wall of the urethra were sutured to reduce the distance between the bladder and the urethra. Finally, the bladder and urethra were anastomosed. The postoperative urinary continence recovery and the clinical effect were recorded. Results The operation time of 31 patients ranged from 80 to 210, with an average of 139.7 minutes. Intraoperative bleeding was 50-330 ml, with an average of 144.2 ml. None of the patients switched to open surgery during the operation, and there was no injury to large vessels and rectum, and no anastomotic leakage. Postoperative pathology showed 21 cases of pT2 stage, 10 cases of pT3 stage, 2 cases of positive margin, including 1 case of basal part and 1 case of apex part, both of which received medical cast

关 键 词：前列腺切除术 膀胱颈重建 黏膜外翻 尿失禁 

分 类 号：R699.8[医药卫生—泌尿科学]