改良膀胱尿道吻合法在机器人辅助腹腔镜前列腺癌根治术中的应用(附89例报告)

Clinical application ofmodified urethrovesical anastomosis in robot-assisted radical prostatectomy(Report of 89cases)

目的:探讨改良膀胱尿道吻合法在机器人辅助腹腔镜前列腺癌根治术(RARP)中的应用价值。方法:2014年9月~2016年9月于我院行RARP的89例患者,均采用双针倒刺自膀胱颈5点和7点连续缝合的改良膀胱尿道吻合法,回顾性分析其临床资料,患者年龄44~81岁,平均68岁;术前PSA 0.03~100ng/ml,平均9.8ng/ml;术前病理诊断腺癌88例,间质肉瘤1例;Gleason评分4~9分,平均7.4分。结果:89例手术均顺利完成,无中转开放。手术时间54~147min,平均89min;术中出血20~600ml,平均178ml;术后下床活动时间1~3d,平均1.5d;住院时间5~29d,平均9d。术后出现漏尿3例、感染1例、肠梗阻2例、尿道狭窄2例,均经保守治疗好转;另有1例切口疝经疝修补好转。术后随访1~23个月,平均9.8个月;术后3、6、12个月完全尿控率分别为86.6%(58/67)、92.7%(51/55)和96.9%(31/32)。7例患者出现生化复发,1例患者出现多发转移,1例患者死亡。结论:应用改良膀胱尿道吻合法行机器人辅助腹腔镜前列腺癌根治术安全可行,可降低术后漏尿发生率,有效改善术后尿控,值得进一步推广。

Objective：To explore the value of modified urethrovesical anastomosis in robot-assisted radical prostatectomy（RARP）.Method：From Sep.2014 to Sep.2016,89 patients with prostate cancer underwent RARP.The mean age was 68（range,44-81）years old.The mean PSA before surgery was 9.8（range,0.03-100）ng/ml.Pathological diagnosis before surgery were adenocarcinoma in 88 cases,stromal sarcoma in 1case.The mean Gleason score was 7.4（range,4-9）.Result：All cases were successfully completed without conversion to open operation.The mean operation time was 89（range,54-147）min,and mean blood loss was 178（range,20-600）ml.The mean postoperative activity time was 1.5（range,1-3）days,and mean hospital stay after surgery was9（range,5-29）days.Postoperative complications occurred in 9cases（10.1%）.They were all cured by conservative treatment,except that one case was cured by hernia repair.During the mean follow-up period of 9.8（range,1-23）months,the pad-free continence rate was 86.6%（58/67）,92.7%（51/55）and 96.9%（31/32）respectively at 3,6and 12 months after operation.Only seven patients had biochemical recurrence,one patient experienced multiple metastases and one patient died.Conclusion：RARP with modified urethrovesical anastomosis can reduce the incidence of urinary leakage,effectively improve urinary incontinence,so it is safe and feasible and worthy of further application.