不同术式前列腺癌根治术后腹股沟疝发生情况及其危险因素分析  

Analysis on the occurrence and risk factors of inguinal hernia after radical prostatectomy with different surgical methods

作　　者：朱猛[1] 柳跃鹏 娄雨清 马超 谷军飞[1] 任立新[1] ZHU Meng;LIU Yuepeng;LOU Yuqing;MA Chao;GU Junfei;REN Lixin(Department of Urology,Second Hospital of Hebei Medical University,Shijiazhuang,050000,China)

机构地区：[1]河北医科大学第二医院泌尿外科,石家庄050000

出　　处：《临床泌尿外科杂志》2023年第6期461-465,共5页Journal of Clinical Urology

摘　　要：目的探讨不同术式前列腺癌(PCa)根治术后腹股沟疝(IH)发生情况,分析影响PCa根治术后IH发生的危险因素。方法回顾性选择2018年1月—2021年12月我院泌尿外科收治的156例接受根治性前列腺切除术的PCa患者,收集临床资料,统计术后IH发生情况,采用多因素logistic回归分析PCa根治术后IH的危险因素,Kaplan-Meier绘制PCa根治术后无IH生存曲线。结果6例失访,余150例患者中接受耻骨后根治性前列腺切除术(RRP)治疗23例,接受腹腔镜前列腺切除术(LRP)治疗127例。中位随访20(6~37)个月,共25例(16.67%)发生IH,接受RRP、LRP治疗的PCa患者术后IH发生率分别为37.78%、13.39%。IH组年龄、2型糖尿病、慢性阻塞性肺疾病比例、既往腹部手术史、Gleason 3~5级、pT3a、RRP、腹股沟内环扩张比例均高于无IH组(均P<0.05),BMI、腹外斜肌厚度(TEOM)、腹直肌宽度(WRM)低于无IH组(均P<0.05)。多因素logistic分析结果显示,RRP、pT3a、慢性阻塞性肺疾病是PCa根治术后IH的危险因素(OR=3.865、1.652、1.406,均P<0.05),TEOM、WRM是保护性因素(OR=0.494、0.530,P<0.05)。Kaplan-Meier分析结果显示,RRP、pT3a、慢性阻塞性肺疾病、低TEOM、低WRM的PCa患者根治术后无IH生存率低于LRP、pT1~2、无慢性阻塞性肺疾病、高TEOM、高WRM的PCa患者(均P<0.05)。结论RRP术后IH发生率偏高,手术方式、TEOM、WRM、肿瘤分期、慢性阻塞性肺疾病是PCa根治术后IH发生的相关因素,应加强高危患者干预以降低IH风险。Objective To investigate the incidence and analyze risk factors of inguinal hernia(IH)after radical resection of prostate cancer(PCa)with different surgical methods.Methods A total of 156 PCa patients who received radical prostatectomy in the Urology Department of our hospital from January 2018 to December 2021 were retrospectively selected.Clinical data were collected,and the incidence of postoperative IH was statistically analyzed.Multivariate logistic regression analysis was conducted to analyze the risk factors affecting postoperative IH after PCa radical resection.Kaplan-Meier was used to plot the survival curve without IH after PCa radical resection.Results Among the remaining 150 patients,23 were treated with retropubic radical prostatectomy(RRP)and 127 were treated with laparoscopic radical prostatectomy(LRP).After a median follow-up of 20(6-37)months,25 patients developed IH,with an incidence of 16.67%(25/150).The incidence of IH in PCa patients treated with RRP and LRP were 37.78%and 13.39%,respectively.Age,proportion of type 2 diabetes mellitus,chronic obstructive pulmonary disease,history of previous abdominal surgery,proportion of Gleason grade 3-5,pT3a,RRP and internal inguinal ring dilation in IH group were higher than those in non-IH group(all P<0.05),and body mass index,thickness of external oblique muscle(TEOM)and width of rectus muscle(WRM)were lower than those in non-IH group(all P<0.05).Multivariate logistic analysis showed that RRP,pT3a and chronic obstructive pulmonary disease were risk factors for IH after PCa radical resection(OR=3.865,1.652,1.406,all P<0.05),while TEOM and WRM were protective factors(OR=0.494,0.530,both P<0.05).Kaplan-Meier analysis showed that the IH-free survival rate of PCa patients with RRP,pT3a,chronic obstructive pulmonary disease,low TEOM and low WRM was lower than that of PCa patients with LRP,pT1-2,no chronic obstructive pulmonary disease,high TEOM and high WRM(all P<0.05).Conclusion The incidence of IH after RRP is high,and surgical method,TEOM,WRM,tumor stage

关 键 词：前列腺癌 腹股沟疝 根治性前列腺切除术 危险因素 

分 类 号：R737.25[医药卫生—肿瘤]