改良前列腺尖部分离技术保留尿道周围结构对前列腺癌根治术后即刻尿控的影响  

The effect of modified apical dissection and periurethral structure preservation in the immediate continence recovery after laparoscopic radical prostatectomy

作　　者：王明帅[1] 熊天宇 蒋铭心 钱小松[1] 王思豪 崔韵 牛亦农[1,2] Wang Mingshuai;Xiong Tianyu;Jiang Mingxin;Qian Xiaosong;Wang Sihao;Cui Yun;Niu Yinong(Department of Urology,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100010,China;Department of Urology,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China)

机构地区：[1]首都医科大学附属北京朝阳医院泌尿外科,北京100010 [2]首都医科大学附属北京世纪坛医院泌尿外科,北京100038

出　　处：《首都医科大学学报》2021年第6期973-977,共5页Journal of Capital Medical University

基　　金：国家自然科学基金(81770754)。

摘　　要：目的探索改良前列腺尖部分离技术,保留完整尿道及周围结构对腹腔镜下前列腺根治性切除术后即刻尿控的影响。方法选取2020年9月至2020年12月在首都医科大学附属北京朝阳医院确诊的前列腺癌患者,由同一手术团队完成的连续10例改良的前列腺尖部分离技术腹腔镜下前列腺根治性切除病例,收集围手术期资料,评估手术并发症及早期即刻尿控。结果患者平均年龄(68±9)岁,中位东部肿瘤协作组织(Eastern Cooperation Oncology Group,ECOG)评分为1分,中位最高前列腺特异抗原(prostate specific antigen,PSA)为15.05(7.05,31.00)ng/mL,临床分期cT28例、cT31例、cT41例。平均手术时间为(123±26)min,平均出血量约(63±28)mL。中位尿管留置时间为5(5,7)d,术后1周内拔除尿管后24 h内尿控完全恢复的患者9例。术后Clavien I级1例,90 d内无其他更高级并发症。患者病理分期pT2a 2例、pT2c 5例、pT3b 1例、pT42例,Gleason评分3+32例、4+35例、4+5/5+43例。本组10例患者尖部均有肿瘤,4例患者切缘阳性。结论改良前列腺尖部分离技术保留尿道周围结构能够明显改善即刻尿控,然而可能会增加尖部肿瘤的切缘阳性率,需要进一步改进技术,并通过更大样本及更长的随访证实疗效。Objective To explore the effect of modified apical dissection and periurethral structure preservation in the immediate continence recovery after laparoscopic radical prostatectomy. Methods The patients who were diagnosed with prostate cancer in the Department of Urology of Beijing Chaoyang Hospital from September 2020 to December 2020 were selected as the study subjects. Among them, total 10 patients underwent laparoscopic radical prostatectomy with modified apical dissection and periurethral structure preservation by the same surgical team. The perioperative and follow-up data were collected for analyzing the perioperative complication and immediate continence rate. Results The mean age was 68±9, the median Eastern Cooperative Oncology Group(ECOG) score was 1, the median maximum prostate specific antigen(PSA) was 15.05(7.05,31.00)ng/mL. There were 8 cases for cT2, 1 case for cT3, and 1 case for cT4. The mean operative time was(123±26) min and the mean established blood loss was(63±28) mL. The median day of catheter removal was 5(5, 7) days and 9 patients obtained complete urinary continence at the day of catheter removal. One case suffered Clavien I complication postoperatively. Totally 2 cases were diagnosed as pT2 a, 5 cases as pT2 c, 1 case as pT3 b and 2 case as pT4. Gleason score of 2 cases was 3+3, 5 cases 4+3, and 3 cases 4+5/5+4. Four patients had positive apical surgical margin. Conclusion The primary study indicated that the technique of modified apical dissection and periurethral structure preservation could improve the immediate continence rate after laparoscopic radical prostatectomy without compromising complication. However, the apical positive surgical margin was higher. The technique requires further development, and high-quality clinical study was required to confirm the efficacy.

关 键 词：前列腺癌 前列腺根治性切除 尿道 尿控 

分 类 号：R737.25[医药卫生—肿瘤]