全盆底重建技术在提高腹腔镜前列腺癌根治术后即刻尿控中的应用  

A simplified technique for reconstruction of vesicourethral support in laparoscopic radical prostatectomy improves immediate continence

作　　者：陈国韬 董坚[1] 于得水[1] 杨宪法 汪洋[1] 冯宁翰[1] CHEN Guo-tao;DONG Jian;YU De-shui;YANG Xian-fa;WANG Yang;FENG Ning-han(Wuxi No.2 Peopled Hospital Affiliated to Nanjing Medical University,Wuxi,Jiangsu 214000,China)

机构地区：[1]南京医科大学附属无锡二院泌尿外科,江苏无锡214000

出　　处：《中华男科学杂志》2021年第9期793-797,共5页National Journal of Andrology

基　　金：江苏省重点研发计划专项(社会发展)(BE2018629);江苏省科教强卫工程(医学创新团队)专项(CXTDA2017047);江苏省“双创计划”双创博士基金(2019);无锡市卫健委中青年后备拔尖人才资助计划(2020)。

摘　　要：目的:探讨一种简化的全盆底重建方法在腹腔镜下前列腺癌根治术中的作用。方法:选取我院在2017年1月至2019年8月期间施行的122例腹膜外腹腔镜下前列腺癌根治术患者,根据术中是否进行盆底重建分为未重建组(57例)和重建组(65例),比较两组手术时间、出血量、淋巴结清扫比例、神经血管束保留情况、尿漏发生率、尿控恢复情况、术后住院天数、腹腔引流管拔除时间及导尿管拔除时间。结果:未重建组与重建组相比,手术时间、出血量、淋巴结清扫比例、神经血管束保留情况、导尿管拔除时间均无统计学差异(P>0.05)。未重建组、重建组的尿漏发生率分别为8.8%vs 0%,两组比较有统计学差异(P<0.05)。拔管即刻、术后1、3、6、12个月尿控率未重建组分别为0%、38.6%、59.6%、78.9%、87.7%,重建组分别为32.3%、56.9%、80%、84.6%、92.3%,两组比较拔管即刻、术后1、3个月有统计学差异(P<0.05),6个月、12个月无统计学差异(P>0.05)。未重建组、重建组的术后住院天数、腹腔引流管拔除时间分别为[(9.1±4.3)d vs(6.7±1.8)d、(6.9±4.5)d vs(4.8±1.5)d],两组比较均有统计学差异(P<0.01)。结论:探索的一种简化的盆底重建方法可提高早期尿控恢复,特别是拔除尿管即刻尿控,降低术后尿漏发生率,从而缩短腹腔引流管留置时间,缩短术后住院天数。Objective:To investigate the application of a simplified technique for reconstruction of vesicourethral support(RVUS)in laparoscopic radical prostatectomy(LRP).Methods:From January 2017 to August 2019,122 patients with localized prostate cancer underwent extraperitoneal LRP,65 with RVUS(the RVUS group)and 57 without RVUS(the non-RVUS group).We compared the operation time,intraoperative blood loss,rate of pelvic lymph node dissection,neurovascular bundle sparing,incidence of urethrovesical anastomotic urinary leakage(UVAUL),postoperative urinary continence,postoperative hospital stay,intraperitoneal drainage tube removal time,and urethral catheter removal time between the two groups of patients.Results:No statistically significant differences were observed between the two groups in the operation time,intraoperative blood loss,rate of pelvic lymph node dissection,neurovascular bundle sparing,or urethral catheter removal time(P>0.05).The incidence rate of UVAUL was lower in the non-RVUS than in the RVUS group(8.8%vs 0%,P<0.05),and so were the rates of postoperative urinary continence immediate after(0%vs 32.3%,P<0.05)and at 1 month(38.6%vs 56.9%,P<0.05),3 months(59.6%vs 80%,P<0.05),6 months(78.9%vs 84.6%,P>0.05)and 12 months after catheter removal(87.7%vs 92.3%,P>0.05).The postoperative hospital stay was dramatically longer in the non-RVUS than in the RVUS group([9.1±4.3]vs[6.7±1.8]d,P<0.01)and so was the intraperitoneal drainage tube removal time([6.9±4.5]vs[4.8±1.5]d,P<0.01).Conclusion:The simplified technique for reconstruction of vesicourethral support in laparoscopic radical prostatectomy improves early urinary continence,especially immediate continence,decreases the incidence rate of urethrovesical anastomotic urinary leakage,and shortens the intraperitoneal drainage tube removal time and postoperative hospital stay.

关 键 词：腹腔镜下前列腺癌根治术 盆底重建 即刻尿控 尿漏 

分 类 号：R699[医药卫生—泌尿科学]