前列腺癌根治术膀胱壁重建新尿道的术后早期影像学特点及功能评价  

Early imaging characteristics and functional evaluation of bladder wall reconstruction neourethra after robot-assisted laparoscopic prostatectomy for prostate cancer

作　　者：官正辉 赵杰 沈晓颖 王江平 GUAN Zhenghui;ZHAO Jie;SHEN Xiaoying;WANG Jiangping(Graduate School,Dalian Medical University,Dalian 116000;Department of Urology,Taizhou People's Hospital,Taizhou 225300,China)

机构地区：[1]大连医科大学研究生院,辽宁大连116000 [2]泰州市人民医院泌尿外科,江苏泰州225300

出　　处：《现代泌尿外科杂志》2024年第7期607-611,共5页Journal of Modern Urology

基　　金：2022年度南京医科大学泰州临床医学院科研项目(No.TZKY20220210)。

摘　　要：目的 采用磁共振成像(MRI)及排泄性尿道造影(VCUG)技术评价膀胱壁重建新尿道(BWN)在前列腺癌根治术后的早期影像学特点及功能。方法 选取2021年3月—2023年6月于泰州市人民医院接受采用BWN技术的机器人辅助腹腔镜下前列腺癌根治术(RALP)的36例患者,术后通过MRI测量其新尿道长度、尿道壁厚度及管腔形态,其中19例患者继续在VCUG下观察新尿道在储尿期、排尿期及排尿中断时的形态特点。结果 患者的年龄中位数为73.00(68.00,76.25)岁,前列腺体积为(45.01±7.18)cm^(3),术前总前列腺特异性抗原水平中位数为10.77(7.30,14.86)ng/mL。T1期患者2例,T2期25例,T3期9例。Gleason评分为≤6分、7分、≥8分的患者分别有7例、21例及8例。危险分级中低危、中危、高危分别有2例、26例及8例。术后拔除尿管后患者1、3、6个月尿控率分别为91.67%、97.22%及100%。36例患者均行MRI检查,测得新尿道长度中位数为15.13(12.71,20.26)mm,尿道壁厚度中位数为6.84(6.18,8.20)mm,管腔具有完整的肌层和黏膜层,黏膜层形似花瓣状,尿失禁患者可见新尿道及吻合口有尿液残留。19例行VCUG的患者中16例尿控患者的新尿道在储尿期关闭,排尿期开放,排尿中断期可关闭,3例尿失禁患者新尿道在储尿期和排尿中断期不能较好地闭合。结论 MRI和VCUG直观地显示了BWN技术可成功建立新尿道且功能良好,提示该技术有助于提高RALP术后的早期尿控。Objective To evaluate the early imaging characteristics and function of bladder wall reconstruction neourethra(BWN)after robot-assisted laparoscopic prostatectomy(RALP)for prostate cancer with magnetic resonance imaging(MRI)and voiding cystourethrography(VCUG).Methods A total of 36 patients who underwent RALP using BWN technique at Taizhou People's Hospital during Mar.2021 and Jun.2023 were enrolled.Postoperative MRI was used to measure the length,wall thickness,and lumen shape of the new urethra.The morphology of the new urethra in 19 patients was observed under VCUG during the storage phase,voiding phase,and interrupted voiding phase.Results The patients'median age was 73.00 years(range:68.00 to 76.25),the prostate volume was(45.01±7.18)cm^(3),and the median total prostate-specific antigen(tPSA)level was 10.77 ng/mL(range:7.30 to 14.86).Two patients were classified as T1 stage,25 as T2,and 9 as T3.Gleason scores were<6 in 7 patients and≥8 in 8 patients.Risk classification was low risk in 2 patients and high risk in 8 patients.Postoperatively,urinary control rates at 1,3,and 6 months were 91.67%,97.22%,and 100%,respectively.MRI revealed a median new urethra length of 15.13 mm(range:12.71 to 20.26)and a median wall thickness of 6.84 mm(range:6.18 to 8.20).The urethral lumen had a complete muscular layer and mucosal layer,which appeared petal-like.In patients with urinary incontinence,residual urine was visible in the new urethra and at the anastomosis site.Of the 19 patients who underwent VCUG,16 could close the new urethra during the storage and interupted voiding phases,and open it during the voiding phase;3 could not close it well during the storage and interrupted voiding phases.Conclusion MRI and VCUG clearly demonstrate that the BwN technique can successfully create a new urethra with good functionality,which helps improve urinary control after RALP for prostate cancer.

关 键 词：机器人辅助腹腔镜下前列腺癌根治术 盆腔核磁共振 排泄性尿道造影 膀胱壁重建新尿道 尿控 

分 类 号：R736.21[医药卫生—肿瘤]