保留膀胱颈联合尿道横纹括约肌重建对腹腔镜前列腺癌根治术后尿控的影响

Effects of bladder neck preservation and reconstruction of rhabdosphincter on urinary continence recovery after laparoscopic radical prostatectomy

目的了解联合使用保留膀胱颈（BNP）和尿道横纹括约肌（RS）重建对腹腔镜前列腺癌根治术后患者尿控的影响。方法选择自2011年1月至2012年12月，中日友好医院泌尿外科18例在腹腔镜前列腺癌根治术（ LRP）中采用了BNP和RS重建技术的前列腺癌患者（ BNP＋RS组），以同期18例采用常规LRP手术方法治疗的前列腺癌患者作为对照组，观察两组的手术时间、术中出血量、术后切缘阳性率、漏尿和尿控功能恢复的情况。结果36例LRP均经腹膜外完成，无中转开放，BNP＋RS组和对照组的中位手术时间、术中出血量、术后切缘阳性例数和漏尿例数分别为164（125～245）min和142（95～210）min，195（80～550）ml和230（120～400）ml，3和2例，0和2例。BNP＋RS组和对照组术后3、6、12个月具有完全尿控能力患者的比例分别为12例（66.7％）和5例（13.9％），15例（83.3％）和11例（30.6％），16例（88.9％）和13例（36.1％）。 BNP＋RS组术后3个月的尿控比例显著高于对照组（P＝0.044），其余差异均无统计学意义（P＝0.264、0.402）。结论在腹腔镜前列腺癌根治术中使用BNP＋RS技术可显著提高患者术后3个月内的尿控能力。

Objective To retrospectively analyze the effects of bladder neck preservation （ BNP ） and reconstruction of rhabdosphincter （ RS） on urinary continence recovery for patients after laparoscopic radical prostatectomy （ LRP）.Methods Bladder neck preservation plus reconstruction of rhabdosphincter （ BNP＋RS） was employed in 18 prostate cancer patients after LRP from January 2011 to December 2012.Eighteen contemporary cases of routine LRP were selected for control group.The operative duration , blood loss volume , postoperative surgical margins , urine leakage and continence rate were compared between two groups.Results LRP was successfully performed through extraperitoneal space in all 36 cases.There was no conversion into open surgery.The median operative duration , blood loss volume , positive surgical margins and urine leakage rate in BNP ＋RS and control groups were 164（125-245）versus 142（95-210）min, 195 （80-550 ） versus 230 （ 120 -400 ） ml, 3 versus 2 cases and 0 versus 2 cases respectively.At 3, 6, 12 months, the continence rates in BNP ＋RS and control groups were 12 cases （66.7%） versus 5 cases （13.9%, P=0.044）, 15 cases（83.3%） versus 11 cases（30.6%, P=0.264） and 16 cases （88.9%） versus 13 cases（36.1%, P=0.402）respectively.A significant higher continence rate in the first 3 months postoperatively was found in BNP ＋RS group than control group.Conclusion BNP plus RS reconstruction after LRP can significantly improve continence in the first 3 months after operation.