腹腔镜下根治性前列腺切除术膀胱尿道单针连续吻合法

Single needle running suture method for urethrovesical anastomosis during laparoscopic radical prostatectomy

目的介绍一种简单易行的腹腔镜下膀胱尿道连续吻合法。方法前列腺癌患者45例。均行根治性前列腺切除术，并采用单针连续吻合法进行膀胱尿道吻合：首先在膀胱后壁4点处做一单纯全层缝合并打结固定；然后在其附近处另起1针做顺时针膀胱尿道单纯连续缝合；从5点到8点处，每点吻合l针以确保后壁的严密；以后每2点吻合1针；为防止滑脱，每吻合3针做1针锁边吻合；最后在2点处与原预留线尾打第2个结完成吻合。吻合膀胱壁时遵循“由外到内”原则，吻合尿道壁时遵循“由内到外”原则；如出现吻合口漏，则加用单纯缝合来修补。结果所有吻合均顺利完成。吻合时间12～25min，平均16min。手术时间112～185min，平均132min。尿管留置7～14d，平均9d。3例因发生暂时性漏尿需延长尿管留置时间至2周。44例（97．8％）术后1年内完全尿控，1例（2．2％）因轻微尿失禁每天使用尿垫2片；无尿道缩窄及其他短期或永久性并发症。结论单针连续缝合法耗时短，相对简单，易于掌握，并发症并未相麻增加。

Objective To describe the single needle running suture method for the urethrovesical anastomosis during laparoscopic radical prostatectomy（LRP）. Methods Forty-five patients of prostate cancer underwent LRP with the single needle running suture method. The technique was initiated by performing a fixing suture at the posterior lip of bladder neck at 4 o＇clock and tying the first knot. Another suture at the nearby position of the first suture was performed to leave the first knot outside. From 5 o＇clock to 8 o＇ clock, sutures were performed every one o＇ clock to secure posterior approximation, then every two o＇clock a suture. To avoid a loose anastomosis, lock sutures were performed every 3 sutures. After completing the full circumference, the needle was drawn at the 2 o＇clock for the second knot. The needle was always driven full-thickness outside-in in the bladder neck and inside-out on the urethra. Any remaining leakage could be closed with additional interrupted sutures. Results All urethrovesical anastomosis were completed successfully. The mean anastomosis time was 16 min（from 12 to 25 min）, and mean operative time was 132 min （112 to 185 min）. The mean catheterization time was 9 d（7 to 14 d）. Three temporal urinary leaks requiring prolonged catheterization were identified. Forty-four patients had total urinary control in 1 year postoperatively and no other short-term or persistent complication was found with a mean follow-up of 21 months. Conclusion The single needle running suture method could be a simple and safe method for urethrovesicat anastomosis during LRP.