摘要
目的探讨保留"尿道系膜"的腹腔镜下前列腺根治性切除术(LRP)对中高危前列腺癌(PCa)患者术后即刻尿控、早期尿控恢复的安全性及有效性。方法回顾性分析2021年7月至2021年11月同一术者所行的18例LRP患者病例资料,所有患者均保留"尿道系膜"。平均年龄为(69±7)岁,平均前列腺体积(45±16)ml,术前PSA≥10 ng/ml 13例,BMI为(24.1±2.5)kg/m^(2)。结果18例患者顺利完成手术,手术时间299(267,397)min;术中失血量50(50,100)ml。术后病理均为前列腺腺泡型腺癌,Gleason评分9分4例,8分2例,7分8例,6分4例;术后TNM分期为T_(2a)~T_(4)期;4例患者术后切缘阳性(22%)。术后平均留置尿管时间(11±5)d。4例患者出现术后并发症,Clavien-DindoⅡ级2例,其中1例尿道感染,1例伤口感染;Clavien-DindoⅢ级2例,1例拔管后尿潴留;1例吻合口瘘尿。术后3个月复查PSA未见生化复发。拔管后即刻、1周、1个月及3个月尿控恢复率分别为61%、72%、77%及83%。结论LRP时保留"尿道系膜"及其附着对中高危PCa术后早期尿控恢复是一种可行的术式。
Objective To investigate the safety and efficacy of immediate and early recovery of postoperative urinary continence by retaining the urethral mesentery during laparoscopic radical prostatectomy(LRP)in patients with moderate and high-risk prostate cancer(PCa).Methods The clinical data of 18 LRP patients who underwent the same operation from July 2021 to November 2021 were retrospectively analyzed.All patients retained the urethral mesentery.The mean age was(69±7)years,the mean prostate volume was(45±16)ml,ther were 13 cases of preoperative prostate specific antigen(PSA)≥10 ng/ml,and body mass index(BMI)was(24.1±2.5)kg/m^(2).Results 18 patients were completed the operation successfully,the median operation time was 299(267,397)minutes and the median intraoperative blood loss was 50(50,100)ml.Postoperative pathology was all prostate adenocarcinoma,Gleason score was 9 in 4 cases,8 in 2 cases,7 in 8 cases,and 6 in 4 cases.Postoperative TNM stage was T_(2a)-T_(4).Surgical margins were positive in 4 patients(22%).The average indwelling time of catheter was(11±5)days.Postoperative complications occurred in 4 patients.Among them 2 cases were Clavien-Dindo classⅡ,including 1 urinary tract infection and 1 wound infection.2 cases were Clavien-Dindo gradeⅢ,including 1 urinary retention after extubation and 1 anastomotic leakage.PSA re-examination 3 months after the operation showed no biochemical recurrence.The continence rate was 61%,72%,77%and 83%immediately,1 week,1 month and 3 months after extubation.Conclusion Retaining the urethral mesentery improves early recovery of urinary continence after LRP in middle and high risk PCa patients.
作者
李俊涛
张天佑
叶雷
郭强
吴坚坚
尧冰
王德娟
邱剑光
Li Juntao;Zhang Tianyou;Ye Lei;Guo Qiang;Wu Jianjian;Yao Bing;Wang Dejuan;Qiu Jianguang(Department of Urology,the Sixth Affiliated Hospital of Sun Yat-sen University,Guangzhou 510655,China)
出处
《中华腔镜泌尿外科杂志（电子版）》
2024年第1期19-24,共6页
Chinese Journal of Endourology(Electronic Edition)
基金
广东省自然科学基金面上项目(2019A1515010386)
关键词
尿道系膜
前列腺切除术
尿控
前列腺癌
解剖
Urethral mesentery
Radical prostatectomy
Urinary control
Prostate cancer
Anatomy
