双手连续性缝合打结技术在腹腔镜下前列腺癌根治术中的应用  

An ambidextrous suture technique for vesicourethral anastomosis in laparoscopic radical prostatectomy

作　　者：刘利杰[1] 杨冉星[1] 洪西 俞建军[1] Liu Lijie;Yang Ranxing;Hong Xi;Yu Jianjun(Department of Urology,the Sixth People's Hospital,Shanghai Jiaotong University,Shanghai 200233,China)

机构地区：[1]上海市第六人民医院泌尿外科,200233

出　　处：《国际泌尿系统杂志》2020年第1期26-29,共4页International Journal of Urology and Nephrology

摘　　要：目的探讨双手连续性缝合打结技术在腹腔镜下前列腺癌根治术中的优势和应用价值。方法选取2013年1月至2014年10月在本院行腹腔镜下前列腺癌根治术的患者62例,收集并比较患者术前基本资料,如年龄、PSA水平、Gleason评分、前列腺体积等。在腹腔镜手术过程中处理耻骨后血管复合体和膀胱尿道吻合时,32例采用左右手缝合打结技术手术(改进组),30例采用常规右手缝合打结技术(对照组)。两组患者手术同期进行,避免由于术者手术操作熟练度不同导致的效果差异。术后随访1年,比较两组患者的手术时间、术中出血量、术后引流管留置时间、平均住院天数、拔管后及术后3个月尿失禁发生率、术后生化复发及术后吻合口狭窄发生情况等。结果所有患者手术均获成功,无中转开放。改进组手术时间(97.8±23.5)min,明显短于对照组(123.7±27.8)min(P<0.05);与对照组相比,改进组引流管留置时间及住院天数也明显缩短(P<0.05);拔管后尿失禁发生率改进组更低(31.3%vs.56.6%,P<0.05),随访3个月两组患者的尿失禁发生率差异无统计学意义(P>0.05);改进组有1例出现术后吻合口狭窄,对照组有5例(P<0.05)。而两组患者在术中出血量,切缘阳性率及术后生化复发率差异无统计学意义。结论腹腔镜下前列腺癌根治术有创伤小、出血少、术后恢复快等优势,通过双手灵活缝合打结技术改良后,可进一步缩短手术时间,减少引流时间和住院天数,并降低术后并发症发生率,是值得推广的安全、有效的微创术式。Objective To explore the advantages and application value of the ambidextrous suture technique for vesicourethral anastomosis in laparoscopic radical prostatectomy(LRP).Methods A randomized study among 62 patients with prostate cancer undergoing LRP from January 2013 to October 2014,32 patients using the ambidextrous continuous suture technique(ambidextrous group)and 30 patients using the conventional right hand continuous suture technique(control group)in the reconstruction of vesico-urethral were collected and follow-up at our institution.Preoperative baseline data,operative time,intraoperative blood loss,postoperative incontinence rate and average hospital stay were compared between the two groups.T-test and Chi-square test were used for statistical analysis.Results The 62 patients underwent LRP successfully,and no one was converted to open surgery.Operating time for the ambidextrous group versus the control group was(97.8±23.5)min vs.(123.7±27.8)min(P<0.05),and the incontinence rates were 31.3%vs.56.6%after the catheter removal(P<0.05),12.5%vs.16.6%at 3 months(P>0.05).Meanwhile,the ambidextrous group possessed shorter negative pressure drainage time and hospital stay.There were six postoperative complications(anastomotic stricture):one in ambidextrous group and five in control group.No urinary retention or anastomosis leak was observed.Conclusions Obtained results support the use of ambidextrous continuous suture technique in LRP.This may significantly improve the surgical skills of surgeons and the quality of life of patients.Limitations include the small sample size and the long learning curve.

关 键 词：前列腺切除术 腹腔镜 缝合技术 

分 类 号：R737.25[医药卫生—肿瘤]