术前MRI参数对腹腔镜根治性前列腺切除术术后早期尿控的预测  

Preoperative MRI parameters for prediction of early urinary continence after laparoscopic radical prostatectomy

作　　者：关迪[1] 向文静 刘跃新[1] 刘丹[1] 谷翊群 平浩 GUAN Di;XIANG Wen-jing;LIU Yue-xin;LIU Dan;GU Yi-qun;PING Hao(Department of Urology,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China;Department of Urology,Liangshan First Hospital,Xichang,Sichuan 615099,China;Laboratory of Chinese National Health Commission for Male Reproductive Health/Science and Technology Research Institute of Chinese National Health Commission,Beijing 100081,China)

机构地区：[1]首都医科大学附属北京同仁医院泌尿外科,北京100730 [2]凉山彝族自治州第一人民医院泌尿外科,四川西昌615099 [3]国家卫健委男性生殖健康重点实验室/国家卫健委科学技术研究所,北京100081

出　　处：《中华男科学杂志》2024年第8期709-716,共8页National Journal of Andrology

基　　金：国家自然科学基金面上项目(82072833)。

摘　　要：目的:收集术前核磁共振成像(MRI)所得图像测量的尿路结构相关参数,探究其与腹腔镜根治性前列腺切除术(LRP)术后早期尿控的关联性,为术后发生尿失禁的高危人群筛选提供理论依据。方法:经严格的筛选后共纳入自2015年1月至2021年2月在首都医科大学附属北京同仁医院确诊为前列腺癌并行LRP的49例患者,患者年龄50~78岁,随访时间1年。术前通过收集患者完整资料,提取可能与术后早期尿控情况相关的临床数据,同时测量MRI图像所示可能与尿控相关的解剖结构参数,并收集术后早期患者尿控恢复情况的相关数据—尿垫使用数量。采用SPSS23.0对数据进行基础统计学分析,经单因素相关分析筛选可能相关因素(P<0.1),再采用R4.0.3或SPSS23.0对纳入的因素与尿控结果进行多因素Logistic回归分析。结果:MRI图像测量所得前列腺前后径长度为(4.0±1.11)cm;前列腺左右径长度为(4.6±0.83)cm;前列腺上下径长度为2.4~6.4 cm;膜部尿道长度(MUL)为(13.16±3.52)mm;尿道横纹括约肌厚度范围为1.08~4.37 mm。多因素分析结果显示年龄与术后1个月尿控是否恢复存在相关性(P=0.035,OR=0.16)。尿道横纹肌厚度与术后3个月(P=0.011,OR=0.02)、术后9个月(P=0.014,OR=0.039)、术后12个月(P=0.014,OR=0.039)尿控是否恢复存在相关性。对于术后12个月仍存在尿失禁的患者,尿道横纹括约肌小于或等于1.6 mm,尿失禁较为严重[P=0.010,OR(95%置信区间)=(0.858,6.240)]。MUL与患者术后9个月(P=0.024,OR=0.508)及12个月(P=0.024,OR=0.508)尿控是否恢复呈正相关。前列腺体积、前列腺各径线、以及研究过程中纳入的可能与术后尿控情况存在相关性的因素在分析过程中显示无明显统计学意义。结论:尿道横纹肌厚度与患者早期尿控是否恢复呈正相关,且尿道横纹括约肌越薄,患者尿失禁程度越严重。MUL与早期尿控是否恢复呈正相关。年龄是LRP术后1个月尿控是否恢Objective:To explore the correlation of early urinary continence(UC)after laparoscopic radical prostatectomy(LRP)with relevant preoperative MRI parameters of the urinary tract structure and provide some theoretical evidence for screening the high-risk population with postoperative urinary incontinence.Methods:This study included 49 PCa patients aged 50-78 years treated by LRP in Beijing Tongren Hospital from January 2015 to February 2021,and all followed up for 12 months.We collected the complete baseline data on the patients,the clinical data possibly related to early postoperative UC,the MRI anatomical parameters associated with UC,and the data on the recovery of early postoperative UC.We recorded the number of urinary pads used,submitted the data obtained to SPSS 23.0 statistical analysis,and identified the possible relevant factors by univariate correlation analysis,followed by R40.3 or SPSS 23.0 multivariate logistic regression analysis of the included factors and the results of UC.Results:MRI images manifested that the prostate anteroposterior diameter averaged(4.0±1.11)cm,the transverse diameter(4.6±0.83)cm,the cephalocaudal diameter 2.4-6.4 cm,the membranous urethral length(MUL)(13.16±3.52)mm,and the thickness of the urethral rhabdosphincter(URS)1.08-4.37 mm.Multivariate analysis showed that age was significantly correlated with the recovery of UC at 1 month after LRP(P=0.035,OR=0.16),and so was the URS thickness at 3 months(P=0.011,OR=0.02),9 months(P=0.014,OR=0.039)and 12 months(P=0.014,OR=0.039).Urinary incontinence with the URS thickness≤1.6 mm at 12 months after operation was found of a high severity(P=0.010,OR[95%CI]=0.858-6.240).The MUL was positively correlated with the recovery of UC at 9 months(P=0.024,OR=0.508)and 12 months(P=0.024,OR=0.508)postoperatively.Correlation analysis revealed that the prostate volume,prostate diameter and other factors included in this study were not significantly correlated to postoperative UC.Conclusion:The thickness of the URS is positively correlated with the

关 键 词：腹腔镜根治性前列腺切除术 尿失禁 尿道横纹括约肌 核磁共振成像 

分 类 号：R737.25[医药卫生—肿瘤]