联合保留最大尿道长度和膀胱颈的尿道重建术在机器人前列腺癌根治术早期尿控中的应用  

Urethral realignment with maximal urethral length and bladder neck preservation in robot-assisted radical prostatectomy:early urinary continence recovery

作　　者：曲发军 张宗勤 吴震杰 王林辉 崔心刚 QU Fajun;ZHANG Zongqin;WU Zhenjie;WANG Linhui;CUI Xingang(Shanghai Pudong New Area Gongli Hospital Affiliated to Naval Medical University,Shanghai 200135,China;the Second Affiliated Hospital of Naval Medical University,Shanghai 200003,China;the Third Affiliated Hospital of Naval Medical University,Shanghai 200003,China)

机构地区：[1]海军军医大学附属上海浦东新区公利医院,上海200135 [2]海军军医大学第二附属医院,上海200003 [3]海军军医大学第三附属医院,上海200003

出　　处：《机器人外科学杂志（中英文）》2020年第3期174-179,共6页Chinese Journal of Robotic Surgery

基　　金：国家自然科学基金面上项目(81772747);国家自然科学基金青年科学基金项目(81702501);上海市浦东新区公利医院人才培养计划资助(拔尖人才,GLRB2019-01);第二军医大学青年启动基金(2016QN22);浦东新区医学学科建设项目:临床高峰学科-泌尿外科(PWYgf2018-03)。

摘　　要：目的:评估使用膀胱颈保留术(Bladder neck preservation,BNP)和最大尿道长度保留术(Maximal urethral length preservation,MULP)进行机器人辅助前列腺癌根治术(Robot-assisted radical prostatectomy,RARP)对术后早期尿控恢复的治疗意义。方法:回顾性分析2018~2019年本中心施行机器人前列腺癌根治术的患者信息,纳入标准为Gleason评分≤7(3+4)、≤cT2c分期以及PSA<20ng/ml,排除在磁共振成像显示膀胱颈或前列腺尖部受累的患者。共有24例患者接受联合保留最大尿道长度和膀胱颈的尿道重建术。尿控定义为不穿垫子或只穿一个安全垫。结果:拔除导尿管后即刻(术后2周),以及术后1个月、3个月和6个月的尿控率分别为12(50.0%)、18(75.0%)、20(83.3%)和23(95.8%),2例患者出现尿瘘(8.3%),未见手术切缘阳性病例。结论:对于Gleason评分≤7的局限性前列腺癌患者,联合使用BNP和MULP的尿道重建技术可实现RARP术后尿控快速恢复。Objective:To evaluate early recovery of urinary continence after robot-assisted radical prostatectomy(RARP)with urethral realignment using bladder neck preservation(BNP)and maximal urethral length preservation(MULP).Methods:Patients who underwent RARP between 2018 and 2019 owing to prostate cancer with a Gleason score<7(3+4),≤cT2c stage,and prostate-specific antigen level<20ng/ml were investigated.Patients with tumors of the bladder neck or apex on magnetic resonance imaging were excluded.24 patients in total underwent RARP with BNP and MULP urethral realignment.Continence was defined as wearing no pad(or one).Results:The continence rates were 12(50%),18(75%),20(83.3%)and 23(95.8%)respectively after Foley catheter removed at 2 weeks 1 month,3 and 6 months after operation.2(8.3%)cases were found urine fistula and no positive surgical margin found.Conclusion:Urethral realignment under BNP and MULP can accelerate the continence recovery after RARP in young patients with localized prostate cancer and Gleason score≤7.

关 键 词：机器人前列腺癌根治术 膀胱颈保留术 最大尿道长度保留术 早期尿控 局限性前列腺癌 

分 类 号：R654[医药卫生—外科学] R737[医药卫生—临床医学]