机器人辅助腹腔镜下根治性前列腺切除术后早期拔除导尿管的临床疗效

A clinical study of early catheter removal after robot-assisted laparoscopic prostatectomy

目的总结机器人辅助腹腔镜下根治性前列腺切除术(RALP)后早期拔除导尿管的临床疗效。方法回顾性分析2016年12月至2018年1月期间157例接受RALP的前列腺癌患者的临床资料,分为术后7d拔除导尿管组(n=55)和术后14d拔除导尿管组(n=102)。术后7d拔除组中位年龄68(63~72)岁;术后14d拔除组中位年龄68(63~72)岁。临床分期T2aN0M0~T4N0M0期,其中T2a期36例,T2b期24例,T2c期64例,T3a期18例,T3b期10例,T4期8例。Gleason评分6~10分,其中<7分35例,7分75例,>7分47例。记录患者拔除导尿管后有无发生尿潴留、即刻漏尿量、疼痛评分(VAS)、术后1个月和3个月尿控恢复情况。结果两组均没有发生尿潴留。术后7d拔除组、术后14d拔除组拔管后即刻漏尿量中位数分别为5(5~15)、10(5~16.25)mL(P=0.118);术后1个月尿控恢复分别为18.18%(10/55)、20.59%(21/102)(P=0.923);术后3个月尿控恢复分别为40.38%(21/55)、42.16%(43/102)(P=0.63);差异均无显著性统计学意义。拔管当天VAS评分术后7d拔除组显著优于术后14d组,差异具有显著统计学差异(P<0.001)。结论RALP术后早期拔除导尿管在无法行膀胱造影的前提下仍然安全、有效,可以有效减轻患者疼痛症状,不影响近期尿控恢复。

Objective To analyze the clinical outcome of early catheter removal after robot-assisted laparoscopic prostatectomy(RALP).Methods The clinical date of 157 prostate cancer patients treated with RALP during Dec.2016 and Jan.2018 were retrospectively analyzed.The patients were divided into 7 d group(catheter removed 7 days after operation,n=55)and 14 d group(catheter removed14 days after operation,n=102).The median age was 68(63-72)years in7 d group and68(63-72)years in14 d group.The classification of clinical stages in this study ranged from T2 aN0 M0 to T4 N0 M0,including T2 a in 36 cases,cT2 b in24 cases,T2 c in64 cases,T3 a in18 cases,T3 b in10 cases,and T4 in8 cases.Gleason score ranged from6 to10,including<7 in 35 cases,=7 in 75 cases,and>7 in 47 cases.After catheter removal,the following data were recorded,including incidence of acute urinary retention,urinary leakage volume,visual analogue scale(VAS),urinary continence 1 month and 3 months after operation.Results No acute urinary retention was observed.The urinary leakage volume was 5(5-15)mL in 7 d group and10(5-16.25)mL in14 d group(P=0.118).The 1 month urinary continence recovery was 18.18%(10/55)in7 d group and20.59%(21/102)in14 d group(P=0.923).The 3 month urinary continence recovery was 40.38%(21/55)in 7 d group and 42.16%(43/102)in 14 d group(P=0.63).There was no statistical difference in VAS between the two groups(P<0.001).Conclusion Early catheter removal after RALP can be safe and effective even without cystography.It can relieve pain without affecting short-term urinary continence.