不同缝合方式对前列腺癌根治术后膀胱尿道吻合口狭窄发生率的影响

The influence of different suture techniques to the anastomotic stricture incidence rate after radical prostatectomy

目的:评估在前列腺癌根治术中,以间断或连续缝合等2种不同的方法处理尿道膀胱吻合口后,远期尿道狭窄发生率的情况。方法:在2006～2010年间,国内3个临床中心共进行了549例开放或腹腔镜前列腺癌根治术。其中388例以间断缝合的方法处理膀胱尿道吻合口,161例以连续缝合的方法处理尿道膀胱吻合口,并评估术后吻合口狭窄发生率的情况。结果:45例(8.2%)患者出现术后尿道吻合口狭窄,发生的平均时间为术后4.1个月。在以间断缝合法处理吻合口的388例开放前列腺癌根治术患者中,10.1%(39例)的患者出现尿道狭窄;而在以连续吻合法处理的161例患者中,尿道狭窄发生率为3.7%(6例),其中75例开放前列腺癌根治术后发生率为2.7%(2例),86例腹腔镜前列腺癌根治术患者术后发生率为4.7%(4例)。结论:无论是以开放的或腹腔镜途径,用连续缝合法处理前列腺癌根治术中的尿道膀胱吻合口,术后吻合口狭窄的发生率低于间断缝合法。

Objective： To analyze the incidence of anastomosis stricture after radical prostatectomy with two different anastomotic methods, interrupted or running suture. Method： A retrospective analysis was performed for 549 patients with prostate carcinoma who underwent RRP or laparoscopic radical prostatectomy（LRP） between 2006 and 2010 in 3 Asian institutions. Interrupted （n = 338） and running （n = 161 ） suture were used for anasto- mosis. Postoperative anastomotic stricture incidence were compared. Result ： AS developed in 45 patients （8.2 %） after a median time of 4.1 months of operation. The incidence of AS is 10.1 % （39 cases） when the vesicourethral anastomosis was performed with routine six interrupted sutures in 388 RRP patients. When the running sutures was adopted including 75 of RRP and 86 LRP cases, the incidence of AS decreased to 3.7% （6 cases） , 2 and 4 patients, respectively. Conclusion： According to our experiences, vesicourethral anastomosis be performed by running sutures whatever in RRP or LRP has a lower AS incidence than routine six interrupted sutures.