改良三明治法尿道重建术对腹腔镜前列腺根治术后早期尿控的疗效分析  

Modified sandwich urethral reconstruction in laparoscopic radical prostatectomy improves early recovery of urinary continence

作　　者：关翰 陈志军[1] 王成勇[1] 杨帅[1] 代昌远 许斌 陈明 GUAN Han;CHEN Zhi-jun;WANG Chen-yong;YANG Shuai;DAI Chang-yuan;XU Bin;CHEN Ming(Department of Urology,The First Affiliated Hospital of Bengbu Medical College,Bengbu,Anhui 233000,China;Department of Urology,Zhongda Hospital Affiliated to South East University,Nanjing,Jiangsu 210009,China)

机构地区：[1]蚌埠医学院第一附属医院泌尿外科,安徽蚌埠233000 [2]东南大学附属中大医院泌尿外科,江苏南京210009

出　　处：《中华男科学杂志》2020年第4期316-320,共5页National Journal of Andrology

基　　金：安徽省高校自然科学重点项目(KJ2018A0214,KJ2019A0355);蚌埠医学院第一附属医院优秀青年科学基金(2019byyfyyq09);蚌埠医学院第一附属医院科技发展基金(Byyfykj201805)。

摘　　要：目的:探讨改良三明治法尿道重建术在腹腔镜前列腺根治术中对膀胱尿道吻合的安全性及术后对患者早期尿控恢复的疗效分析。方法:回顾性分析2018年1月至2019年9月20例采用改良三明治法尿道重建的腹腔镜前列腺根治术患者资料与同时期21例未采用此法进行重建的患者资料,对比分析其吻合时间、手术时间、早期尿控恢复情况等临床资料。结果:两组患者年龄、体质量指数、前列腺活检组织Gleason评分、前列腺体积、术前PSA等均无统计学差异(P>0.05),手术时间、术中出血量、引流管留置时间、术后进食时间、术后住院时间等两组无统计学差异(P>0.05),改良三明治组出现1例术后吻合口狭窄,行尿道扩张后痊愈;常规法组出现1例吻合口瘘,延长留置尿管5 d后痊愈。随访拔除尿管后尿控恢复率,改良三明治组在12周时尿控恢复率显著高于对照组(80.0%vs 47.6%,P=0.031)。结论:腹腔镜前列腺根治术中采用改良三明治法尿道重建技术安全、可行、有效,能够显著提高术后尿控率,有利于患者排尿功能的恢复。Objective: To explore the safety of modified sandwich urethral reconstruction(MSUR) in laparoscopic radical prostatectomy(LRP) and its effect on the early recovery of urinary continence. Methods: We retrospectively analyzed the clinical data on 20 patients treated by LRP with MSUR(the MSUR group) and another 21 cases of LRP without MSUR(the conventional control group) from January 2018 to September 2019. We compared the two groups of patients in the general data, anastomosis time, operation time and urinary continence recovery. Results: There were no statistically significant differences between the two groups of patients in the age, body mass index, Gleason scores, prostate volume and baseline PSA level(P > 0.05) or in operation time, intraoperative blood loss, drainage tube indwelling time, postoperative feeding time and postoperative hospital stay(P > 0.05). Anastomotic stenosis occurred in 1 case in the MSUR group postoperatively, which was cured after regular urethral dilation, and anastomotic fistula developed in 1 case in the control group, which was healed after 5 days of prolonged catheterization. The recovery rate of urinary continence at 12 weeks after catheter removal was significantly higher in the MSUR than in the control group(80.0% vs 47.6%, P < 0.05). Conclusion: Modified sandwich urethral reconstruction in LRP is a safe, effective and feasible surgical strategy, which can significantly improve postoperative urinary continence recovery of the patient.

关 键 词：前列腺根治术 腹腔镜 改良三明治法 尿控率 

分 类 号：R699.6[医药卫生—泌尿科学]