保留控尿功能的腹腔镜前列腺癌根治术

Continence-Sparing Laparoscopic Radical Prostatectomy

目的探讨保护控尿功能的前列腺癌根治术的技术要点。方法对收治的94例T_(1b)～T_(2c)前列腺癌患者行保留控尿功能的前列腺癌根治术,即腹腔镜下精细解剖前列腺尖部,保护EUS及其控尿神经,膀胱颈后唇成形后与尿道吻合;并同前期42例行常规前列腺癌根治术(LRP)的患者比较,术后30、60和90 d评估患者的控尿状况。控尿标准:站立或行走时无尿液漏出,或全天使用尿垫不超过1块。结果术后30、60 d控尿率LRP组为27.7%(13/47)、66.0%(31/47);CSLRP组为55.3%(26/47)、85.1%(40/47),均有统计学差异(x^2=7.406,4.663,P<0.05)。术后90 d两组控尿率为78.7%(37/47)和91.5%(43/47)(x^2=3.02,P>0.05)。结论利用腹腔镜的优点,保护EUS和膀胱颈后唇成形加强尿道后壁,能明显加快前列腺癌根治术后控尿的恢复时间。

Objective To compare the surgical outcome between standard laparoscopic radical prostatectomy and continency-sparing laparoscopic radical prostatectomy, in order to explore the surgical technique of protecting unitary continence. Methods 94 patients who had prostate cancer with TNM stage of T1b-T2c were enrolled in this study and underwent continency-sparing laparoscopic radical prostatectomy, in which EUS and the nerves distributing to the rhabosphincter muscles were protected during a sharp dissection in apical prostate, followed by the reconstruction of posterior wall of the bladder neck. Continence was defined as no pads or one diaper/24h and was assessed 30,60, and 90 d after the surgery, comparing with that in historical group with 42 cases by LRP. Results At 30, 60 d after the surgery, continence recovery rate of LRP group and CSLRP was 27.7%（13/47）, 66.0%（31/47） and 55.3%（26/47）,85.1%（40/47） respectively. A statistically significant difference was present between the CSLRP and LRP group （Χ^2=7.406,4.663,P〉0.05）. At 90 d after the procedure, the continence recovery rate was 78.7%（37/47） and 91.5%（43/47） respectively （Χ^2=3.02,P〉0.05%）. Conclusions Laparoseopieally dissection of apex of prostate proximal to the nerves distributing to rhabdosphineter muscles and reconstruction of posterior wall of the bladder neck is facilitated to rapid reeorvery of urinary control after the surgery.