腹腔镜根治性前列腺切除术中保留膀胱颈在术后控尿的效果观察

Urinary continence in laparoscopic radical prostatectomy with bladder neck preservation

目的:探讨保留膀胱颈在术后控尿中的作用以及对切缘阳性率的影响。方法:回顾性分析2006年7月-2010年5月期间对145例T1b^T2c局限性前列腺癌患者行腹腔镜根治性前列腺切除术资料,其中保留膀胱颈59例,不保留膀胱颈86例。使用国际尿控协会调查问卷,分别在术后1个月、3个月、6个月评估患者的控尿情况。结果:在术后1个月、3个月、6个月,保留膀胱颈组的控尿率分别为42.4%、74.6%、86.4%,不保留膀胱颈组的控尿率分别为25.6%、58.1%、80.2%。在术后1个月和3个月两组的控尿率差异有统计学意义(P=0.034和P=0.042),而在术后6个月两组间控尿率差异无统计学意义(P=0.331)。两组阳性切缘位于膀胱颈的各1例,两组切缘阳性率相近(P=0.954)。结论:腹腔镜根治性前列腺切除术中保留膀胱颈对术后的早期控尿有着积极作用,而且不增加术后的切缘阳性率。

Objective： To assess the effect of bladder neck preservation （BNP） on postoperative continence during laparoscopic radical prostatectomy. Methods： One hundred and forty-five patients with localized prostate cancer （T1b-T2c） underwent laparoscopie radical prostatectomy in our center from July 2006 to May 2010,including 59 cases treated with bladder neck preservation （BNP group） and 86 cases with bladder neck resection （non-BNP group）. All cases were diagnosed as prostate cancer by transrectal ultrasonography-guided prostate biopsy preoperatively, in which localized tumors were confirmed by CT or MRI and distant metastases were ruled out by ECT bone scan. All patients had no history of incontinence and no radiation therapy preoperatively. All the 145 operations were performed by the same surgeon. The bladder neck preservation was defined as a procedure of direct suturing of the bladder neck on the urethra without repair and reconstruction of the bladder neck. Both procedures of neurovascular bundle preservation and external striated urethral sphincter preservation were carried out on all cases. Urinary continence was evaluated using the International Continence Society questionnaire at 1,3 and 6 months postoperatively. Positive surgical margins rates were compared between the two groups. Postoperative continence was defined as the absence of need for pads or the use of one pad daily. Results ： At 1,3 and 6 months,the urinary continence rates were 42.4% ,74.6% and 86.4% in BNP group, respectively, while 25.6% ,58. 1% and 80.2% in non-BNP group, respectively. There were statistically significant differences in continence at 1 and 3 months between two groups （ P 〈 0. 05 ）, while no significant differences were observed at 6 months postoperatively （P = 0.331 ）. There were no significant differences in overall rate of positive surgical margins between two groups （10.1% vs 10.4% ; P =0. 954） and both groups had one case with positive surgical margins at bladder neck. Conclusion： Bladder neck preservation during laparoscopic radical prostatectomy is helpful for postoperative continence without increase of positive surgical margins rate.