腹腔镜下前列腺根治性切除术中吻合技术对吻合口并发症的影响

Influence of suture technique on anastomotic complication in laparoscopic radical ;prostatectomy

目的：比较腹腔镜下前列腺根治性切除术中不同的膀胱尿道吻合方式对吻合口并发症的影响。方法回顾性分析2012年6月至2015年6月诊断为局限性前列腺癌并行腹腔镜下前列腺根治性切除术121例患者的临床资料，根据膀胱尿道吻合方式不同分为两组，采用间断缝合方式36例（间断缝合组），采用连续缝合方式85例（连续缝合组），比较两组手术时间、术后吻合口漏尿、拔管后吻合口狭窄及术后1、3、6个月尿失禁情况的差异。结果121例腹腔镜下前列腺根治性切除术均获成功，无中转开放手术。连续缝合组尿道膀胱吻合时间短于间断缝合组[（20.35±3.10）min比（34.02±3.94）min]，吻合口漏尿发生率[3.53%（3/85）比16.67%（6/36）]、吻合口狭窄发生率[2.35%（2/85）比13.89%（5/36）]、术后1个月尿失禁发生率[15.29%（13/85）比33.33%（12/36）]、术后3个月尿失禁发生率[7.06%（6/85）比25.00%（9/36）]、术后6个月尿失禁发生率[2.35%（2/85）比13.89%（5/36）]均低于间断缝合组，差异有统计学意义（P＜0.05）。结论腹腔镜下前列腺根治性切除术中采用连续缝合的膀胱尿道吻合方式可缩短手术时间，降低吻合口漏尿、吻合口狭窄及尿失禁等并发症的发生。

Objective To compare the effect of different urethrovesical anastomosis methods on postoperative anastomotic complication in laparoscopic radical prostatectomy （LRP）. Methods The clinical method of 121 patients with localized prostate cancer who underwent LRP from June 2012 to June 2015 was retrospectively analyzed. The patients were divided into two groups according to different urethrovesical anastomosis methods： interrupted suture group with 36 patients and continuous suture group with 85 patients. The operation time, postoperative anastomosis leakage, anastomosis stenosis and urinary control status 1, 3 and 6 month after operation were compared between two groups. Results All the operations were completed successfully without converting to open approach. The operating time of continuous suture group and interrupted suture group was （20.35 ± 3.10）min and （34.02 ± 3.94） min, the rate of postoperative anastomosis leakage was 3.53%（3/85） and 16.67%（6/36）, the rate of anastomosis stenosis was 2.35%（2/85） and 13.89%（5/36）, the rate of urinary incontinence after operation for 1 month was 15.29%（13/85） and 33.33%（12/36）, for 3 months was 7.06%（6/85） and 25.00%（9/36）, for 6 months was 2.35% （2/85） and 13.89% （5/36）, there were significant differences （P〈0.05）. Conclusions Continuous suture can shorten operation time, decrease the risk of anastomotic leakage, anastomosis stenosis and urinary incontinence.