腹腔镜前列腺癌根治术后控尿功能恢复与术前膜性尿道长度的相关性研究

Relationship between preoperative membranous urethral length and recovery of urinary continence after iaparoscopic radical prostatectomy

目的探讨腹腔镜前列腺癌根治术后控尿功能恢复与患者术前磁共振成像（MRI）测量的膜性尿道长度（membranous urethral length,MUL）的相关性。方法回顾性分析2008年6月至2009年10月于我院行腹腔镜前列腺癌根治术50例患者的资料，年龄61～82岁，平均73岁。穿刺前PSA1．89～40．24μg／L，平均10．27μg／L。所有患者术前控尿功能良好，均经前列腺穿刺活检诊断为前列腺腺癌。所有患者于穿刺术前行MRI检查并测量MUL为10．2—23．5mm，平均14．6mm，分为A组（MUL〈14mm）27例，B组（MUL≥14mm）23例。由同一名医师行腹腔镜前列腺癌根治术。术后随访1年，记录患者术后控尿功能的恢复情况。结果所有患者手术均顺利完成，术后随访12～28个月，平均18．6个月。A、B组术后3个月尿控率分别为77．8％和45．6％，差异有统计学意义（P〈0．05），6个月和12个月尿控率分别为85．2％和69．6％、92．6％和86．7％，差异均无统计学意义（P〉0．05）。A、B两组术后3个月分别有2例（7．4％）和1例（4．3％）重度尿失禁患者，差异无统计学意义（P〉0．05），两组术后6个月和12个月无重度尿失禁患者；两组术后控尿功能恢复曲线比较差异有统计学意义（P〈0．05）。结论MUL〈14mm的患者行腹腔镜前列腺癌根治术，术后控尿功能恢复延迟，术后早期（3个月）尿失禁的发生率明显增高。

Objective To discuss whether recovery of urinary continence after laparoscopic radical prostateetomy is associated with membranous urethral length. Methods Fifty cases with pathologic confirmed prostate carcinoma were performed laparoscopic radical prostatectomy by a single surgeon. Patients were categorized into two groups according to membranous urethral length （MUL） on preoperative magnetic resonance imaging （Group A： MUL 〈 14 ram; Group B： MUL≥ 14 ram）. The MUL was measured on coronal images as the distance from the prostatic apex to the entry of the urethra into the penile bulb. After surgery we recorded and analyzed recovery of urinary continence of patients at one-year post operation. In the 50 patients, The mean membranous urethral length was 14.6 （10.2 -23.5） mm by MRI. Results All pa- tients completed operation successfully. Three months after surgery, group A had 77.8% patients and group B had 45.6% were completely continent （P 〈 0.05）. Six months after surgery, the continence rate was 85.2% and 69.6% （P〉0.05）. At one year, they were 92.6% and 86.7% （P〉0.05） for groupA and B. There was 2 patients （7.4%） in Group A and 1 patients （4.3%） in Group B had severe incontinence three months after surgery （P 〉 0.05）. There was no patient had severe incontinence at six months or one year after surgery. There was a significant difference between group A and group B in the urinary continence curve （P 〈 0.05）. Conclusions Shorter membranous urethra lengths could be associated with slower recovery of urinary continence, especially for early recovery （3 months） of continence after laparoscopic radical prostatectomy.