免缝扎DVC保留前列腺尖部包膜的腹腔镜下膀胱根治性切除原位新膀胱术对尿控与勃起功能的影响  

Effect of laparoscopic radical cystectomy and in situ neobladder surgery without suturing DVC and preserving prostatic apex capsule on urinary control and erectile function

作　　者：陈梦杰 高旭东 王金行 郭园园 杨小淮[1] 刘贝贝[1] Chen Mengjie;Gao Xudong;Wang Jinhang;Guo Yuanyuan;Yang Xiaohuai;Liu Beibei(Department of Urology,the First Affiliated Hospital of Bengbu Medical College,Bengbu 233000,China)

机构地区：[1]蚌埠医学院第一附属医院泌尿外科,蚌埠233000

出　　处：《国际泌尿系统杂志》2023年第3期452-457,共6页International Journal of Urology and Nephrology

基　　金：国家自然科学研究重点项目(81702495);安徽省自然科学研究重点项目(1808085QH279);安徽省高校自然科学研究项目(KJ2021A0706);蚌埠医学院研究生科研创新项目(Byycs21078)。

摘　　要：目的探究免缝扎阴茎背深静脉复合体(DVC)保留前列腺尖部包膜的腹腔镜下膀胱根治性切除原位新膀胱术对尿控与勃起功能的影响。方法回顾性分析2019年1月至2021年3月在本院行腹腔镜下膀胱根治性切除原位新膀胱术的32例膀胱癌患者的临床资料,其中14例行免缝扎DVC保留前列腺尖部包膜的腹腔镜下膀胱根治性切除原位新膀胱术(改良组);18例行常规腹腔镜下膀胱根治性切除原位新膀胱术(常规组)。比较两组手术时间、术中出血量、导尿管留置时间、引流管留置时间、新膀胱容量、残余尿量、最大尿流率、尿道狭窄率、术后尿控功能、勃起功能等临床指标。结果改良组术后的早期日间尿控率和术后半年的国际勃起功能指数明显高于常规组(均P<0.05),两组的手术时间、术中出血量、导尿管留置时间、引流管留置时间、输血率、漏尿率、新膀胱容量、残余尿量、最大尿流率、尿道狭窄率、血肌酐变化值、远期日间尿控率、夜间尿控率比较,差异均无统计学意义(均P>0.05)。结论免缝扎DVC保留前列腺尖部包膜技术在腹腔镜下膀胱根治性切除原位新膀胱术中是安全可行的,能显著改善术后早期日间尿控功能与勃起功能,且不增加术中出血风险和尿道狭窄发生率。Objective To investigate the effect of laparoscopic radical cystectomy and in situ neobladder surgery without suturing dorsal vascular complex(DVC)and preserving prostatic apex capsule on urinary control and erectile function.Methods The clinical data of 32 patients with bladder cancer who underwent laparoscopic radical cystectomy and orthotopic neobladder in our hospital from January 2019 to March 2021 were retrospectively analyzed.Among them,14 patients underwent laparoscopic radical cystectomy and orthotopic neobladder with preservation of the prostatic apex capsule(modified group).Eighteen patients underwent conventional laparoscopic radical cystectomy with orthotopic neobladder(conventional group).The operation time,intraoperative bleeding,indwelling time of catheter,indwelling time of drainage tube,neobladder volume,residual urine volume,maximum urinary flow rate,urethral stricture rate,postoperative urinary control function,erectile function and other clinical indexes were compared between the two groups.Results The daytime urinary control rate in the early postoperative period and the half a year postoperative erectile function index in the modified group were significantly higher than that of the routine group(all P<0.05).There was no significant difference in the operation time,intraoperative bleeding,catheter retention time,drainage tube indwelling time,rectal injury rate,blood transfusion rate,urine leakage rate,neobladder volume,residual urine volume,maximum urine flow rate,urethral stenosis rate,blood creatinine change value,long-term daytime urine control rate,night urine control rate index between the modified group and the routine group(all P>0.05).Conclusions It is safe and feasible to use DVC suture-free and preserve the prostatic apex capsule technique in laparoscopic radical cystectomy with in situneobladder.It can significantly improve the early postoperative diurnal urinarycontrol function and erectile function almost without increasing the risk of intraoperative bleeding and the incidence

关 键 词：膀胱切除术 背深静脉复合体 包膜 尿控 勃起功能障碍 

分 类 号：R737.14[医药卫生—肿瘤]