摘要
目的 比较3D腹腔镜与2D腹腔镜下根治性前列腺切除术对患者术后尿控恢复的影响方法 回顾分析在2013年1月至2015年12月我院72例分别行3D腹腔镜和2D腹腔镜下根治性前列腺切除术患者的临床资料.3D组38例,平均年龄（64.2 ±6.0）岁;体重指数（22.8 ±2.2）kg/m2;术前PSA（14.5 ±7.6）ng/ml;前列腺体积（41.4±9.1）ml;Gleason评分≤6分13例,7分17例,≥8分8例;临床分期T1期2例,T2期26例,T3a期9例,T3b期1例;术前行磁共振（MRI）检查测得膜部尿道长度（membranous urethral length,MUL）为（15.6 ±2.6）mm.2D组34例,年龄（61.9 ±6.6）岁;体重指数（21.7±1.9） kg/m2;术前PSA（16.7 ±6.8）ng/ml;前列腺体积（42.1±10.6） ml;Gleason评分≤6分10例,7分18例,≥8分6例;临床分期T1期1例,T2期28例,T3a期5例;术前MUL为（15.5±2.5）mm.两组一般资料比较差异均无统计学意义（均P＞0.05）.所有患者术前排尿、控尿功能良好,均经前列腺穿刺活检诊断为前列腺癌,穿刺后6周行根治性前列腺切除术.所有手术均由同一术者完成.比较两组患者的手术时间、出血量、膀胱颈-尿道吻合时间、术后MUL、手术前后MUL差值、术中输血率、术后漏尿发生率、术后切缘阳性率以及拔除导尿管2、4、8、12、24、36周尿控恢复情况.结果 本研究72例手术均顺利完成,无中转开放手术.3D组的膀胱颈-尿道吻合时间少于2D组[（12.9±1.7）min与（15.7 ±2.6）min,P=0.021],手术前后MUL差值＜2D组[（0.5 ±0.1）mm与（0.6±0.2）mm,P=0.044].两组的手术时间[（162.7±17.1）min与（175.7±15.7）min,P=0.802]、术中出血量[（191.1 ±31.6）ml与（211.8 ±43.2）ml,P=0.21]、术中输血率[5.2％ （2/38）与8.8％ （3/34）,P=0.662]、术后漏尿发生率[7.9％ （3/38）与14.7％ （5/34）,P=0.463]、术后MUL[（15.1 ±2.6）mm与（15.0 ±2.6）mm,P=0.767]等比较差异均无统计学意义.两组术后病理检查的切缘均为阴性.3D组和2D组拔除导尿管后8周的控尿率分别为60.5％ （23/38）和35.3％ （12/34）,12周的控尿率分别为73.7％ （28/38）和47.1％ （16/34）,差异均有统计学意义（P =0.037,P=0.029）,其他时间点控尿率比较差异均无统计学意义（均P ＞0.05）.结论 与2D腹腔镜相比,3D腹腔镜下根治性前列腺切除术有助于患者早期控尿功能的恢复.
Objective To Compare the postoperative recovery of continence after 3D and 2D laparoscopic radical prostatectomy.Methods A retrospective analysis of 72 patients underwent radical prostatectomy in our department from January 2013 to December 2015,including 38 cases underwent 3D laparoscopic radical prostatectomy,3D group＇s mean age was （64.2 ± 6.0）years,mean of preoperative PSA was （14.5±7.6）ng/ml,Gleason score （13 cases≤6,17 cases =7,8 cases ≥8）,the mean prostate volume （41.4 ±9.1） ml,the classification of clinical stage in 3D group included 2 cases in cT1,26 cases in cT2,9 cases in cT3a,1 cases in cT3b,mean body mass index was （22.8 ± 2.2） kg/m2,mean of MUL （membranous urethral length） was （15.6 ±2.6） mm;34 cases in the 2D group,3D group＇s mean age was （61.9 ±6.6）years,mean of preoperative PSA was （16.7 ±6.8） ng/ml,Gleason score （10 cases≤6,18 cases =7,6 cases ≥8）,the mean prostate volume （42.1 ± 10.6） ml,the classification of clinical stage in 3D group included 1 cases in cT1,28 cases in cT2,5 cases in cT3a,mean body mass index was （21.7 ± 1.9） kg/m2,mean of MUL（membranous urethral length） was （15.5 ± 2.5） mm.All patients got a good function of micturition and urinary continence before the surgery.We compared surgical time,bladder neckurethral anastomosis time and blood loss in two groups.Membranous urethral length（MUL） were measured on preoperative and postoperative magnetic resonance imaging （MRI）.Postoperative continence rate was analyzed at 2 weeks,4 weeks,8 weeks,12 weeks,24 weeks and 36 weeks after the remove of the catheter.Results All the operations were completed successfully by the same surgeon and none was transferred to open surgery.The age,PSA value,Gleason score,prostate volume,TNM stage,BMI （body mass index）and other relevant aspects of the clinical data showed no significant difference （P 〉 0.05）.The time of bladder neck-urethral anastomosis is less than the 2D group [（12.9 ± 1.7） min and （15.7 ±2.6） min,P =0.021],MUL loss in the 3D laparoscopic surgery group is less than that of 2D laparoscopic [（0.5 ±0.1） ml vs.（0.6±0.2） ml,P =0.044],the two groups in operative time [（162.7 ± 17.1） min vs.（175.7 ± 15.7） min,P =0.802],intraoperative blood loss[（191.1 ± 31.6） ml vs.（211.8 ±43.2） ml,P =0.021],intraoperative blood transfusion rate [5.2% （2/38） vs.8.8% （3/34）,P =0.662],postoperative incidence of urine leakage [7.9% （3/38） vs.14.7% （5/34）,P =0.463],postoperative the MUL [（15.1 ± 2.6） mm vs.（15.0 ± 2.6） mm,P =0.767）,there was no statistically significant differen.All patients were followed up for urinary function at least 36 months.The continence rate between two groups at 8 weeks （60.5% vs.35.3%）,12 weeks （73.7% vs.47.1%） got significantly difference.Conclusions Compared with 2D laparoscopic,3D laparoscopic may help early postoperative recovery of urinary continence after laparoscopic radical prostatectomy.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2017年第3期182-186,共5页
Chinese Journal of Urology
关键词
3D腹腔镜
根治性前列腺切除术
尿控
恢复
3D laparoscopy
Radical prostatectomy
Urinary continence
Recovery
