摘要
目的探讨腹腔镜根治性前列腺癌切除术中行全盆底筋膜重建（totalpelvicfloorreconstruction，TR）对术后尿控功能恢复的影响。方法回顾分析自2013年1月至2013年12月我院泌尿外科同一名医师完成的腹腔镜根治性前列腺癌切除术74例患者临床资料，根据术中是否行全盆底筋膜重建分为TR组（36例）和non-TR组（38例）。两组年龄、前列腺体积、术前PSA、Gleason评分、临床分期等差异无显著性。比较两组手术时间、术中出血、切缘阳性率、围手术期并发症及术后12个月内尿控恢复情况。结果74例手术均顺利完成，无中转开放。术后随访12～26个月。术后1、3个月TR组较non．TR组尿控情况好（术后1个月尿控0、1、2、3级TR组分别为11、15、5、5例，non-TR组为8、7、13、10例，z=-2．182，P=0．029；术后3个月TR组分别为22、7、5、2例，non-TR组分别为12、8、10、8例，z=-2．841，P=0．004，术后6、12个月2组尿控情况差异无显著性（P均〉0．05）。两组手术时间和切缘阳性率等差异无显著性。结论全盆底筋膜重建腹腔镜根治性前列腺癌切除术，有利于术后早期尿控恢复，并不增加切缘阳性率和手术时间。
Objective To evaluate the influence of total pelvic floor reconstruction （TR） technique on the recovery of urinary continence after laparoscopic radical prostatectomy. Mehhods From January 2013 to December 2013 laparoscopic radical prostatectomy was performed by a same surgeon on 74 cases. Of them, 36 underwent total pelvic floor reconstruction（TR group） and 38 underwent no total pelvic floor reconstruction （non-TR）. No significant differences in age, prostate volume, preoperative PSA, clinical stage and Gleason score were found between the two groups. Urinary incontinence was evaluated using a patient self-assessment questionnaire based on the International Consultation on Incontinence Questionnaire. The operative time, estimated blood loss, preoperative PSA, complications, positive surgical margins and urinary continence at 1, 3, 6 months and 1 year after operation were compared between the 2 groups, retrospectively. Results The operation was successful for all cases. The follow-up was from 12 months to 26 months. Patients in TR group had a better urinary continence as compared with patients in non-TR group at 1 month and 3 month after operation. At 1 months, urinary continence degree of 0, 1, 2, 3 Grade was 11, 15, 5, 5 cases in TR group and 8, 7, 13, 10 in non-TR group, Z= -2.182, P=0.029; At 3 months, urinary continence degree of 0, 1, 2, 3 Grade was 22, 7, 5,2 cases in TR group and 12, 8, 10, 8 cases in non-TR group, Z=-2.841, P=0.004,respectively ）.There were no statistical differences between two groups in urinary continence at 6 month and 12 month after operation （p〉0.05, both）. No significant differences in positive surgical margins and operative time were found between the two groups. Conclusion Total pelvic floor reconstruction technique can improve the early recovery of urinary continence after laparoscopic radical prostatectomy without increasing the operative time and the risk of positive surgical margins.
出处
《中国男科学杂志》
CAS
CSCD
2015年第5期31-35,共5页
Chinese Journal of Andrology
