摘要
目的探讨在机器人辅助腹腔镜根治性前列腺切除术中应用尿道周围结构解剖性复位技术的疗效。方法回顾性分析2016年8月至2018年5月收治的108例前列腺癌患者的临床资料,其中58例采用尿道周围结构解剖性复位技术(复位组),50例采用常规吻合方法(常规组)。复位组年龄(73.7±7.3)岁,前列腺体积(40.9±5.8)ml,术前PSA值(11.7±2.4)ng/ml,体重指数(24.2±4.2)kg/m^2;术前Gleason评分3+3分13例,3+4分25例,4+3分20例;临床分期T1c期17例,T2a^T2b期35例,T2c期6例。常规组年龄(71.6±5.4)岁,前列腺体积(39.8±3.1)ml,术前PSA值(13.2±3.5)ng/ml,体重指数(26.3±3.2)kg/m^2;术前Gleason评分3+3分10例,3+4分22例,4+3分18例;临床分期T1c期13例,T2a^T2b期33例,T2c期4例。两组比较差异均无统计学意义(P>0.05)。两组术前均经询问病史、IPSS或尿动力学检查排除尿失禁。常规组吻合膀胱尿道仅用3-0双针可吸收单乔倒刺线,从6点钟方向分别沿顺、逆时针将膀胱尿道连续缝合。复位组在常规组吻合方法的基础上,缝合尿道时将尿道端后缘周围约1 cm的狄氏筋膜和结缔组织薄层缝合带入,并用3-0单乔线将耻骨前列腺裙(耻骨前列腺韧带,盆底筋膜)与膀胱颈前壁即逼尿肌帷断缘进行缝合,恢复尿道前解剖结构。比较两组手术时间、吻合时间、术中出血量、术后留置尿管时间、术后住院时间、术后并发症、术后病理情况,以及术后1、3、6、12个月控尿功能恢复情况等。结果两组手术均顺利完成,均未中转开放或普通腹腔镜手术,无严重术中、术后并发症。复位组手术时间长于常规组[(145.3±12.3)min与(122.4±11.4)min,P<0.05],吻合时间也长于常规组[(31.6±8.2)min与(21.2±4.4)min,P<0.05]。复位组术后留置尿管时间短于常规组[(7.0±0.5)d与(11.0±0.6)d,P<0.05]。复位组与常规组术中出血量[(108.1±8.3)ml与(103.3±10.4)ml]、注水试验失败例数[1例(1.7%)与3例(4.0%)]、术后引流管拔除时间[(3.0±1.2)d与(4.0±1.6)d]、术后住院时间[(8.0±1.1)d与(10.0±1.5)d]和术后并发症发生例数[4例(6.9%)与4例(8.0%)]比较差异均无统计学意义(P>0.05)。复位组pT2a^pT2b期53例、pT2c期5例,常规组pT2a^pT2b期46例、pT2c期4例,两组差异无统计学意义(P>0.05)。复位组和常规组术后GIeason评分6、7、8分分别为19例和15例、30例和25例、9例和10例;复位组和常规组分别有3例和2例切缘阳性,差异均无统计学意义(P>0.05)。两组随访12个月均无生化复发。术后1、3个月复位组的尿控恢复率分别为84.5%(49/58)和89.7%(52/58),均优于常规组的70.0%(35/50)和78.0%(39/50),差异有统计学意义(P<0.05);术后6、12个月两组尿控恢复率差异均无统计学意义[91.3%(53/58)与86.0%(43/50),100.0%(58/58)与96.0%(48/50),P>0.05]。复位组与常规组术后12个月IPSS分别为(10.4±1.6)分和(12.1±1.3)分,尿道狭窄例数分别为0例和2例(4%),差异均无统计学意义(P>0.05)。结论机器人辅助腹腔镜根治性前列腺切除术中采用尿道周围结构解剖性复位技术可减少术后尿管留置时间,并有助于患者早期恢复控尿功能。
Objective To investigate the outcome of patients underwent anatomic periurethral reconstruction during robotic assisted laparoscopic radical prostatectomy(RARP).Methods During August 2016 to May 2018,anatomic periurethral reconstruction was performed during RARP in 58 consecutive patients.The control group consists of another 50 patients had no anatomic periurethral reconstruction procedure during RARP.Perioperative data of these patients were collected retrospectively,including operation time,anastomosis timeintraoperative blood loss,duration of indwelling catheter,length of hospital stay,complications,postoperative pathology,and continence outcome at 1,3,6,12 months after surgery.Results All cases were successfully performed without conversion to open or laparoscopic surgery.There were no major intraoperative or postoperative complications.Operative time and anastomosis time was(145.3±12.3)mins and(31.6±8.2)mins in reconstruction group comparing to(122.4±11.4)mins and(21.2±4.4)in control group(both P<0.05).Duration of indwelling catheter was(7.0±0.5)days in reconstruction group and(11.0±0.6)days in control group(P<0.05).In reconstruction group,estimated blood loss was(108.1±8.3)ml,duration of drainage tube was(3.0±1.2)d,postoperative hospital stay was(8.0±1.1)d,failure of leak test in 1 case,and postoperative complications in 4 cases(6.9%),comparing to(103.3±10.4)ml,(4.0±1.6)d,(10.0±1.5)d,3 cases and 4 cases(8.0%)in control group with no significant difference(all P>0.05).Postoperative pathology confirmed 53 T2a-T2b diseases and 5 pT2c diseases in reconstruction group,in comparison with 46 T2a-T2b and 4 pT2c diseases in non-reconstruction group(P>0.05).There were 19 and 15 cases with a final Gleason score of 6,30 and 27 cases with Gleason 7,9 and 10 cases with Gleason 8,in reconstruction group and non-reconstruction group respectively(all P>0.05).There was no significant difference between the two groups regarding incidence of positive surgical margins(3 in reconstruction group and 2 in control group,P>0.05).The percentage of patients maintain continence in reconstruction group and non-reconstruction group:at 1 month[84.5%(49/58)and 70.0%(35/50)],at 3 months[89.7%(52/58)and 78.0%(39/50)],at 6 months[91.3%(53/58)and 86.0%(43/50)]and 1 year after surgery[100.0%(58/58)and 96.0%(48/50)].Reconstruction group showed better continence outcome at 1 and 3 month(P<0.05),with no statistical differences at 6 month and 1 year.The IPSS 1 year after surgery was 10.4±1.6 and 12.1±1.3,with anastomotic stricture in 0 and 2(4%)patients in reconstruction group and control group,respectively(both P>0.05).ConclusionAnatomic reconstruction of periurethral structure during RARP is safe and feasible with reduced duration of indwelling catheter and better continence outcome.
作者
王帅
祁小龙
刘锋
张琦
毛祖杰
张大宏
Wang Shuai;Qi Xiaolong;Liu Feng;Zhang Qi;Mao Zujie;Zhang Dahong(Department of Urology,Zhejiang Provincial People's Hospital,People′s Hospital of Hangzhou Medical College,Hangzhou 310014,China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2019年第3期194-199,共6页
Chinese Journal of Urology
基金
浙江省医药卫生科技项目(2016KYB009,2018KY263)
浙江省教育厅项目(Y201636959).
关键词
机器人辅助腹腔镜手术
根治性前列腺切除术
尿失禁
快速康复
Robotic assisted laparoscopic surgery
Radical prostatectomy
Incontinence
Enhanced recovery after surgery
