膜部尿道长度与机器人辅助根治性前列腺切除术后早期尿控恢复的相关性研究  

Relationship between membranous urethra length and early continence rate after robotic-assisted radical prostatectomy

作　　者：邵金鹏 叶洲杰 安子彦 赵健 邹昊逾 符宗宇 赵堃 陈晓霞 符伟军[1] Shao Jinpeng;Ye Zhoujie;An Ziyan;Zhao Jian;Zou Haoyu;Fu Zongyu;Zhao Kun;Chen Xiaoxia;Fu Weijun(Senior Department of Urology,PLA General Hospital,Beijing 100039,China;Urology Department,No.960 Hospital of Joint Logistics Support Force of Chinese PLA,Jinan 250031,China;Radiology Department,PLA General Hospital,Beijing 100039,China;Chinese PLA Medical School,Beijing 100853,China;Medical College of Nankai University,Tianjing 300071,China)

机构地区：[1]解放军总医院第三医学中心泌尿外科医学部,北京100039 [2]解放军第960医院泌尿外科,济南250031 [3]解放军总医院第三医学中心放射诊断科,北京100039 [4]解放军医学院,北京100853 [5]南开大学医学院,天津300071

出　　处：《中华泌尿外科杂志》2025年第2期104-109,共6页Chinese Journal of Urology

摘　　要：目的探讨膜部尿道长度(MUL)与机器人辅助根治性前列腺切除术(RARP)后早期尿控恢复的相关性。方法回顾性分析2020年1月至2023年12月解放军总医院收治的71例单一术者行RARP治疗的前列腺癌患者的病例资料。年龄(65.32±6.04)岁,体质量指数(BMI)(25.21±2.59)kg/m^(2)。前列腺体积32.41(24.75,44.40)ml。前列腺特异性抗原(PSA)11.67(8.22,22.66)ng/ml。术前穿刺或手术病理Gleason评分6、7、8、9~10分分别为15例(21.2%)、29例(40.8%)、16例(22.5%)、11例(15.5%)。临床分期cT 1期、cT 2期、cT 3期分别为4例(5.6%)、61例(85.9%)、6例(8.5%)。术前行前列腺多参数MRI检查,测量患者MUL为13.25(10.41,14.99)mm。71例手术,术中保留神经血管束(NVB)13例(18.3%)。根据拔除尿管后1、3个月尿控恢复情况将患者分为尿控恢复组和尿失禁组,分别比较拔管后1、3个月两组的年龄、BMI、前列腺体积、PSA、MUL、术前Gleason评分、临床分期、术中保留NVB例数、病理分期、留置尿管时间的差异。采用多因素logistic回归分析拔管后1、3个月患者尿控恢复的独立影响因素。结果本研究71例手术均顺利完成,术后病理分期pT 2期47例(66.2%),pT 3~4期24例(33.8%);留置尿管时间2.7(2.0,3.0)周。71例随访2个月,拔管后1个月尿控恢复组42例,尿失禁组29例,两组的年龄[(64.93±6.48)岁与(65.79±5.89)岁]、BMI[(26.26±2.52)kg/m^(2)与(24.52±2.42)kg/m^(2)]、前列腺体积[32.00(24.12,41.11)ml与33.00(25.27,47.97)ml]、PSA[12.55(8.31,24.00)ng/ml与11.30(7.92,20.65)ng/ml]、临床分期[cT 1期/cT 2期/cT 3期:2例(4.8%)/35例(83.3%)/5例(11.9%)与2例(6.9%)/26例(89.7%)/1例(3.4%)]、术前Gleason评分[6分/7分/8分/9~10分:6例(14.2%)/18例(42.9%)/12例(28.6%)/6例(14.3%)与9例(31.0%)/11例(37.9%)/4例(13.8%)/5例(17.3%)]、术中保留NVB例数[7例(16.7%)与6例(20.7%)]、病理分期[pT 2期/pT 3~4期:27例(64.3%)/15例(35.7%)与20例(69.0%)/9例(31.0%)]、尿管留置时间[2.6(2.0,3.0)周与2.9(2.0,3.4)Objective To investigate the correlation between membranous urethral length(MUL)and early urinary continence recovery after robot-assisted radical prostatectomy(RARP).Methods A retrospective analysis was conducted on 71 prostate cancer patients who underwent RARP by a single surgeon at the PLA General Hospital between January 2020 and December 2023.Patient characteristics included:age of(65.32±6.04)years,BMI(25.21±2.59)kg/m^(2),prostate volume 32.41(24.75,44.40)ml,PSA 11.67(8.22,22.66)ng/ml.Gleason score[6/7/8/9-10:15(21.2%)/29(40.8%)/16(22.5%)/11(15.5%)],Clinical stage[cT 1/cT 2/cT 3:4(5.6%)/61(85.9%)/6(8.5%)].Measured MUL using multiparametric prostate MRI,median MUL was 13.25(10.41-14.99)mm.Neurovascular bundle(NVB)preservation in 13(18.3%)cases.Patients were grouped based on continence recovery at 1 and 3 months post-catheter removal.Age,BMI,prostate volume,PSA,Gleason score,clinical stage,NVB preservation,pathological stage,catheter indwelling time,and MUL were compared between groups.Multivariate analysis identified independent predictors of continence recovery.Results All 71 surgeries were successful,pathological stage[pT 2/pT 3-4:47(66.2%)/24(33.8%)],and catheter indwelling time 2.7(2.0,3.0)weeks.Follow-up data at 2 months were available for 71 patients,at 1 month,42 patients achieved continence(continence group)and 29 had incontinence(incontinence group).No significant differences were observed between continence and incontinence groups in age[(64.93±6.48)years vs.(65.79±5.89)years],BMI[(26.26±2.52)kg/m^(2)vs.(24.52±2.42)kg/m^(2)],prostate volume[32.00(24.12,41.11)ml vs.33.00(25.27,47.97)ml],PSA[12.55(8.31,24.00)ng/ml vs.11.30(7.92,20.65)ng/ml],Gleason score[6/7/8/9-10:6(14.2%)/18(42.9%)/12(28.6%)/6(14.3%)vs.9(31.0%)/11(37.9%)/4(13.8%)/5(17.3%)],clinical stage[cT 1/cT 2/cT 3:2(4.8%)/35(83.3%)/5(11.9%)vs.2(6.9%)/26(89.7%)/1(3.4%)],NVB preservation[7(16.7%)vs.6(20.7%)],pathological stage[pT 2/pT 3-4:27(64.3%)/15(35.7%)vs.20(69.0%)/9(31.0%)],or catheter indwelling time[2.6(2.0,3.0)weeks vs.2.9(2.0,3.4

关 键 词：前列腺癌 机器人辅助根治性前列腺切除术 尿失禁 膜部尿道长度 

分 类 号：R73[医药卫生—肿瘤]