机器人辅助腹腔镜前列腺癌根治术后尿道膀胱吻合口狭窄处理及危险因素分析  

Risk factors analysis and treatment of vesicourethral stenosis after robot-assisted laparoscopic radical prostatec⁃tomy

作　　者：胡海义[1] 李恭会[2] 丁国庆[2] 成晟[2] 吴海洋[2] 王明超[2] 陈志强[1] HU Haiyi;LI Gonghui;DING Guoqing(Department of Urology,Xiasha Hospital,Sir Run Run Shaw Hospital Affiliated to Medical College of Zhejiang University,Hangzhou 310018,China)

机构地区：[1]浙江大学医学院附属邵逸夫医院下沙院区泌尿外科,浙江杭州310018 [2]浙江大学医学院附属邵逸夫医院泌尿外科

出　　处：《全科医学临床与教育》2020年第5期401-403,共3页Clinical Education of General Practice

摘　　要：目的 探讨机器人辅助腹腔镜前列腺癌根治术(RALRP)后尿道膀胱吻合口狭窄(VS)发生的危险因素以及治疗分析.方法 回顾性分析行RALRP的590例患者的临床资料,筛选出RALRP术后2月后发生排尿困难,且经膀胱镜检查确认为VS的患者.采用logistic回归分析患者年龄、体重指数、糖尿病史、术前前列腺特异性抗原(PSA)水平、出血量、Gleason评分、导尿管留置时间、拔除导尿管后尿白细胞计数与VS发生的关系.结果 在590例行RALRP术的患者中,术后2月后共有24例患者发生VS,狭窄发生率为4.06%.导尿管留置时间长和术后尿白细胞计数高是RALRP患者VS的发生的危险因素(OR分别=4.12、5.81,P均<0.05).24例VS患者中,9例行输尿管镜下球囊扩张术;15例行输尿管镜球囊扩张合并膀胱颈口瘢痕电切术,其中6例伴有Hem-o-lok侵蚀尿道膀胱吻合口予以电切周围瘢痕组织后取出.4例术后再次出现排尿困难,间隔2周后多次行尿道扩张术.所有患者经处理后随访半年以上排尿症状均改善.结论 术后留置导尿管时间、拔除导尿管后尿白细胞计数是RALRP术后发生VS的危险因素,对于VS的治疗,初始治疗多采用输尿管镜探查结合尿道扩张,效果确切.Objective To investigate the risk factors and treatment of vesicourethral stenosis after laparoscopic radical prostatectomy assisted by robot.Methods A total of 590 patients underwent robot-assisted laparoscopic radical prostatectomy were retrospectively analyzed.Two months after robot-assisted laparoscopic radical prostatectomy,the patients with dysuria or urinary retention were screened and further confirmed by cystoscopy as vesicourethral stenosis.The effects of patient age,body mass index,diabetes mellitus,preoperative PSA,intraoperative blood loss,gleason score,catheter duration,postoperative urine leukocyte on the vesicourethral stenosis were analyzed by logistic regression.Results Two months after robot assisted laparoscopic radical prostatectomy,a total of 24 cases occurred vesicourethral stenosis.The incidence was 4.06%.The catheter duration and high level of postoperative urine leukocyte were significantly related with VS(OR=4.12,5.81,P<0.05).Of the 24 cases,9 cases underwent balloon dilatation under ureteroscope,15 cases underwent ureteroscopic balloon dilatation with anastomotic scar resection,among which 6 cases complicated with hem-o-lok erosion were removed by resection of surrounding scar tissue.Four patients had dysuria again,and urethral dilatation was performed several times after 2 weeks.All the patients were followed up for more than six months.The upper urinary obstruction were all improved after individualized treatment.Conclusion Postoperative indwelling urethral catheter time and urine leukocyte count after catheter removal are risk factors for vesicourethral stenosis after robot-assisted laparoscopic radical prostatectomy.For the treatment of vesicourethral stenosis,ureteroscopic exploration combined with urethral dilatation is often used in the initial treatment with ureteroscopy,which has a definite effect.

关 键 词：机器人辅助腹腔镜前列腺癌根治术 膀胱尿道吻合口狭窄 尿道扩张 

分 类 号：R737.25[医药卫生—肿瘤]