“改良三明治”法在腹腔镜下前列腺癌根治术中的尿控效果观察

Urinary continence recovery after“modified sandwich”technique in laparoscopic radical prostatectomy

目的:探讨腹腔镜下前列腺癌根治术应用"改良三明治"法重建尿道的手术安全性以及术后尿控的有效性。方法:回顾性分析潍坊市人民医院泌尿外科2017年1月-2018年12月采用"改良三明治"法尿道重建腹腔镜下前列腺癌根治术(改良组)的患者与同期行常规前列腺癌根治术(传统组)的患者的临床资料,两组均采用筋膜外途径,对比两组患者的年龄、体质量指数(BMI)、穿刺前前列腺特异性抗原(PSA)、穿刺前前列腺体积、穿刺Gleason评分、手术时间、出血量、术后首次复查PSA、术后Gleason评分、术后病理(脉管癌栓、神经侵犯、精囊腺、被膜、尿道前列腺部)及切缘阳性率,随访观察术后尿控情况(拔尿管后1、2、4、12及>12周)。结果:两组患者年龄、BMI、穿刺前PSA、穿刺前前列腺体积、术前和术后Gleason评分差异无统计学意义;手术时间、出血量、术后病理(脉管瘤栓、神经侵犯、精囊腺、被膜、尿道前列腺部)、切缘阳性率、术后首次PSA检查与术前比较差异无统计学意义;改良组拔尿管后4、12周尿控率明显高于传统组(P=0.012,P=0.011)。结论:腹腔镜下前列腺癌根治术应用"改良三明治"法重建尿道,具有安全性和可行性,可以明显改善术后控尿效果,具有临床推广价值。

Objective:To investigate the safety and efficacy of urethra reconstruction via the"modified sandwich"technique of laparoscopic radical prostatectomy(LRP).Methods:We retrospectively analyzed the clinical data of LRP from January 2017 to December 2018,in the Department of Urology,Weifang People’s Hospital.The patients undergoing the"modified sandwich"technique served as experimental group,and those receiving the original technique served as control group.Both groups were treated by extrafascial pathway.The demographic,perioperative and follow-up data were used for comparison.Specifically,the perioperative data included prostate specific antigen(PSA),volume of prostate,Gleason score,surgical duration,bleeding amount,pathology(invasion of vascular,nerve,seminal vesicle,capsule and urethra)and the rate of positive surgical margin(PSM).We followed up the postoperative urinary continence at 1 st week,2 nd week,4 th week,12 th week and then monthly after extubation.Results:There were no statistical differences in demographic and perioperative data.The recovery of the urinary continence was significantly better in the experimental group than in the control group since extubation at 4 th week and12 th week(P=0.012,P=0.011).Conclusion:The"modified sandwich"technique of LRP is safe and feasible in urethral reconstruction,which could significantly improve the urinary continence during the early period of postoperation.