前列腺中叶突入膀胱对腹腔镜下前列腺癌根治术的影响

目的 研究前列腺中叶突入膀胱对腹腔镜下前列腺癌根治术的影响.方法 回顾性分析2017年10月1日至2019年12月31日期间由经验丰富医生主刀腹腔镜下前列腺癌根治术,分析前列腺中叶(PML)与一般情况、手术时间、切缘阳性率、Gleason评分,前列腺体积等的关系.结果 总共有120例病例纳入分析,PML为(0.88±0.72)cm,PML与前列腺体积呈正相关,与患病年龄、身高、体重及BMI均无相关性;PML与离断膀胱颈时间及尿道重建时间显著相关,与围术期血色素下降,术后住院时间无明显相关性;PML≥1cm组切缘阳性率23.08%、术后早期尿瘘率7.69%与PML<1cm组切缘阳性率18.52%、术后早期尿瘘率7.41%不存在显著差异,但是两组的膀胱颈口重建率、术后即刻尿控率、3个月尿控率存在显著差异.结论 前列腺中叶突入膀胱和前列腺体积密切相关,PML越大,会使手术变得更复杂,手术时间更长,更容易产生并发症.对于前列腺中叶明显突入膀胱的患者,采用改良的手术方式可以有效减少手术并发症,降低切缘阳性率.

Objective To study the impact of protnided median lobe(PML)on laparoscopic radical prostatectomy.Methods A retrospective analysis was taken to analyze the laparoscopic radical prostatectomies performed by a doctor in the Department of Urology,Hangzhou First People's Hospital from October 1,2017 to December 31,2019.The relationships between PML and general conditions,operarion time,positive margin rate,Gleason score,prostate volume were analyzed.Results 120 cases were included in the study.The PML was(0.88±0.72)cm,positively correlated with the prostate volume.There was no correlation between PML and other indexes such as age,height,weight and BMI.PML was significantly related to the time of isolating the prostate and bladder,and time of urethral reconstruction.There was no significant correlation between PML and other indexes such as estimated blood loss and postoperative hospital stay.In the group(PML≥1cm)the rate of positive surgical margin was 23.08% and early postoperative urinary fistula was 7.69%while in the other group(PML<1cm)were 18.52%and 7.41%,but the rate of bladder neck reconstruction,rate of urine control after removal of urinary tube and rate of urine control at 3rd month were significantly different.Conclusion Protnided median lobe is related to the volume of the prostate.The larger PML will make the operation more complicated,the operation time much longer,and more prone complications.For patients with a large PML,the improved surgical procedure can efiectively reduce the surgical complications and reduce the rate of positive surgical margin.