保留部分前列腺部尿道和耻骨前列腺韧带在前列腺癌根治术中的应用

Preserving partial prostatic urethra and puboprostatic ligament in radical retropublic prostatectomy

目的探讨保留部分前列腺部尿道和耻骨前列腺韧带在减少前列腺癌根治术后尿失禁中的作用。方法将60例局限性前列腺癌患者随机分为两组,每组30例。Ⅰ组患者行传统耻骨后前列腺癌根治术,Ⅱ组患者采用保留部分前列腺部尿道和耻骨前列腺韧带的方法行耻骨后前列腺癌根治术,分别于术后1、3、6和12个月随访尿失禁情况。结果两组间年龄、前列腺特异抗原(PSA)、Gleason评分和临床分期构成比的差异均无统计学意义(P值均>0.05),两组前列腺尖端切缘均无肿瘤残留,前列腺侧缘阳性率类似。Ⅱ组在术后1、3、6个月的完全尿控率均显著高于Ⅰ组(P值均<0.05)。结论在前列腺癌根治术中保留部分前列腺部尿道和耻骨前列腺韧带可显著提高近期尿控的效果。

Objective To investigate the effects of preserving partial prostatic urethra and puboprostatic ligament on reducing the postoperative urinary incontinence in radical retropubic prostatectomy. Methods A total of 60 patients with localized prostate cancer were randomly divided into 2 groups. Conventional radical retropubic prostatectomy was performed in 30 patients in the group 1, and 30 patients in the group 2 underwent radical retropubic prostatectomy preserving puboprostatic ligament and partial prostatic urethra. The urinary incontinence was evaluated on 1st, 3rd, 6th and 12th months after operation. Results There were no significant differences in age, prostate specific antigen （PSA）, Gleason score and clinical stage between the two groups （all P0.05）. No residual tumor at cutting edge of the prostate apex was found, and the positive ratios of residual tumor on the lateral prostate were similar between two groups. The urinary continence in the group 2 was better than that in group 1 on the 1st, 3rd and 6th months after operation （all P0.05）. Conclusion The preservation of partial prostatic urethra and puboprostatic ligament in radical retropubic prostatectomy is conducive to the short-term recovery of urinary continence.