保留耻骨膀胱复合体对腹腔镜前列腺癌根治术后尿失禁恢复的影响  

Effect of Pubovesical Complex-sparing on Recovery of Urinary Incontinence After Laparoscopic Radical Prostatectomy

作　　者：朱再生[1] 周鹏飞 施红旗[2] 应明亮 薛亚东 徐敏 王跃平 胡洋 肖云渊 胡胜晔 Zhu Zaisheng;Zhou Pengfei;Shi Hongqi(Department of Urology,Jinhua Hospital Affiliated to Zhejiang University School of Medicine,Jinhua 321000,China)

机构地区：[1]浙江大学医学院附属金华医院泌尿外科,金华321000 [2]浙江大学医学院附属金华医院病理科,金华321000 [3]浙江大学医学院附属金华医院医学影像科,金华321000 [4]浙江大学医学院附属金华医院中心实验室,金华321000

出　　处：《中国微创外科杂志》2023年第10期741-745,共5页Chinese Journal of Minimally Invasive Surgery

基　　金：浙江省医药卫生计划项目(2022KY1332);浙江省金华市(社发类)重大科学技术研究计划项目(2021-3-022)。

摘　　要：目的 探讨保留耻骨膀胱复合体的前列腺癌根治术后尿失禁恢复情况。方法 2017年6月~2020年6月,将局限性前列腺癌行腹腔镜根治性前列腺切除(laparoscopic radical prostatectomy, LRP)的患者按住院号分为保留耻骨膀胱复合体的观察组(n=53)和未保留的对照组(n=51)。2组年龄、体重指数、前列腺特异性抗原、穿刺活检Gleason评分、前列腺体积等差异无显著性(P>0.05)。均行保留神经的LRP。根据每天使用尿垫数量评估尿失禁恢复情况。尿失禁完全恢复定义:每天使用尿垫0个。拔除导尿管后至少随访12个月。结果 拔除导尿管当天(24 h),1、3、6和12个月尿失禁完全恢复率观察组均明显高于对照组[39.6%(21/53) vs.17.6%(9/51),P=0.013;66.0%(35/53)vs.35.3%(18/51),P=0.002;84.9%(45/53)vs.56.9%(29/51),P=0.002;92.5%(49/53)vs.70.6%(36/51),P=0.004;98.1%(52/53)vs.84.3%(43/51),P=0.031]。结论 在LRP手术时,保留耻骨膀胱复合体技术能早期快速改善术后尿失禁,并显著减少远期(术后12个月)尿失禁。Objective To investigate the recovery of urinary incontinence after radical prostatectomy for prostate cancer with pubovesical complex-sparing.Methods From June 2017 to June 2020,patients with localized prostate cancer who underwent laparoscopic radical prostatectomy(LRP)were divided by admission number into an observation group with pubovesical complex-sparing(n=53)and a control group without pubovesical complex-sparing(n=51).The differences in age,body mass index(BMI),prostate-specific antigen(PSA),Gleason score on puncture biopsy,and prostate volume between the two groups were not significant(P>0.05).All the patients underwent nerve-preserving LRP.Recovery from incontinence was assessed based on the number of pads used per day.The definition of complete recovery from urinary incontinence was using of 0 pad per day.Follow-ups were conducted for at least 12 months after catheter removal.Results The rates of complete recovery from urinary incontinence on the day of catheter removal(24 h)and at 1,3,6,and 12 months were significantly higher in the observation group than those in the control group[39.6%(21/53)vs.17.6%(9/51),P=0.013;66.0%(35/53)vs.35.3%(18/51),P=0.002;84.9%(45/53)vs.56.9%(29/51),P=0.002;92.5%(49/53)vs.70.6%(36/51),P=0.004;98.1%(52/53)vs.84.3%(43/51),P=0.031].Conclusion At the time of LRP surgery,pubovesical complex-sparing technique provides early and rapid improvement of postoperative urinary incontinence and significantly reduces long-term incidence(12 months postoperatively)of urinary incontinence.

关 键 词：前列腺癌 腹腔镜根治性前列腺切除术 保留耻骨膀胱复合体 尿失禁 

分 类 号：R737.25[医药卫生—肿瘤]