保留膀胱颈对机器人辅助腹腔镜下前列腺根治术后的影响  

Effect of bladder neck preservation on urinary control after robot-assisted laparoscopic radical prostatectomy

作　　者：陈禹杰 许巧 万士豪 张洪瑜 罗生军[1] 何云锋[1] Chen Yujie;Xu Qiao;Wan Shihao;Zhang Hongyu;Luo Shengjun;He Yunfeng(Department of Urology,The First Affiliated Hospital of Chongqing Medical University)

机构地区：[1]重庆医科大学附属第一医院泌尿外科,重庆400016

出　　处：《重庆医科大学学报》2024年第6期736-739,共4页Journal of Chongqing Medical University

摘　　要：目的:探讨在机器人辅助腹腔镜下行前列腺根治术(robot-assisted laparoscopic radical prostatectomy,RARP)时,完整保留膀胱颈(包括内括约肌及近端尿道)对术后尿控的影响。方法:选取2022年10月至2023年8月在重庆医科大学附属第一医院接受RARP的175例前列腺癌患者,根据术中是否保留膀胱颈分为实验组(保留膀胱颈,91例)和对照组(不保留膀胱颈,84例)。比较2组患者的年龄、初始总前列腺特异性抗原(total prostate specific antigen,TPSA)值、手术时间、术中出血量、引流管拔除时间、住院时间、术后并发症、切缘阳性率等一般临床指标,以及拔出尿管后1 d、1个月、3个月和6个月的尿控率和肿瘤复发率,并进行统计学分析。结果:2组患者的一般临床指标比较差异无统计学意义(P>0.05)。2组患者在拔出尿管后1 d及1个月、3个月的尿控率,差异有统计学意义(P<0.05),6个月的尿控率,差异无统计学意义(P>0.05),2组患者半年内均无肿瘤复发。结论:对于完整保留膀胱颈的改良技术,切缘阳性率及肿瘤复发率无明显差异,可以加速尿失禁的早期恢复,提高生活质量,值得在临床推广。Objective:To investigate the effect of complete bladder neck preservation(including the internal sphincter and the proxi-mal urethra)on urinary control after robot-assisted laparoscopic radical prostatectomy(RARP).Methods:A total of 175 patients with prostate cancer who underwent RARP in The First Affiliated Hospital of Chongqing Medical University from October 2022 to August 2023 were enrolled,and according to whether the bladder neck was preserved during surgery,they were divided into experimental group(91 patients with bladder neck preservation)and control group(84 patients without bladder neck preservation).The two groups were compared in terms of the general clinical indices including age,initial total prostate-specific antigen(TPSA)value,time of operation,intraoperative blood loss,drainage tube removal time,length of hospital stay,postoperative complications,and positive rate of resection margin,as well as urinary control rate and tumor recurrence rate at 1 day,1 month,3 months,and 6 months after urinary catheter re-moval,and a statistical analysis was performed.Results:There was no significant difference in general clinical indices between the two groups(P>0.05).There was a significant difference in urinary control rate at 1 day,1 month,and 3 months after urinary catheter re-moval between the two groups(P<0.05),while there was no significant difference in urinary control rate at 6 months(P>0.05);no tu-mor recurrence was observed in either group within 6 months.Conclusion:There are no significant differences in the positive rate of re-section margin and tumor recurrence rate for the modified technique of complete bladder neck preservation,which can accelerate the early recovery of urinary incontinence and improve quality of life,and therefore,it holds promise for clinical application.

关 键 词：机器人 腹腔镜前列腺根治术 保留膀胱颈 术后尿控 

分 类 号：R737.25[医药卫生—肿瘤]