分析前列腺癌患者行腹腔镜前列腺癌根治术后控尿状况

Analysis of Urinary Control Status of Prostate Cancer Patients after Laparoscopic Radical Prostatectomy

目的探讨前列腺癌患者行腹腔镜前列腺癌根治术后控尿状况。方法回顾性分析2015年1月—2019年9月期间徐州医科大学附属宿迁医院泌尿外科收治的37例行腹腔镜前列腺癌根治术治疗的前列腺癌患者的临床资料,调查并记录患者术后6个月控尿恢复状况,统计患者术后控尿状况的影响因素。结果该组37例患者术后6个月有26例患者恢复控尿,恢复率70.27%。控尿恢复患者年龄(59.86±3.47)岁和前列腺体积(40.65±4.62)mL小于未恢复者(67.21±4.16)岁及(47.63±5.57)mL,术前IPSS(8.12±0.36)分低于未恢复者(10.48±2.43)分(t=5.259、3.782、3.347,P<0.05);膀胱颈、前列腺部尿道以及血管神经束保留率69.23%、76.92%及80.77%高于未恢复者18.18%、27.27%及36.36%,差异有统计学意义(χ^(2)=6.186、6.128、5.077,P<0.05);控尿恢复者BMI(25.06±2.33)kg/m2和未恢复者BMI(25.12±3.38)kg/m2,差异无统计学意义(t=0.056,P>0.05);恢复者肿瘤分期中Ⅰ~Ⅱ期42.31%、Ⅲ~Ⅳ期57.69%,和未恢复者Ⅰ~Ⅱ期45.45%、Ⅲ~Ⅳ期54.55%,恢复者肿瘤低分化42.31%、中分化26.92%,高分化30.77%,未恢复者肿瘤低分化36.36%、中分化36.36%,高分化27.27%,差异无统计学意义(χ^(2)=0.035、0.035、0.001、0.033、0.033,P>0.05)。Logistic多因素显示患者术后控尿状况的影响因素包括患者年龄、IPSS评分、术前列腺体积、患者膀胱颈、前列腺部尿道以及血管神经束保留情况,Exp(B)为1.266、2.848、1.125、12.335、14.264、15.416,95%CI分别为1.071~1.455、1.043~1.236、1.238~124.758、1.562~5.123、1.165~158.731、1.536~96.852;BMI、肿瘤分期以及分化程度与患者术后控尿状况无关,差异无统计学意义(P>0.05)。结论前列腺癌患者行腹腔镜前列腺癌根治术后控尿状况影响因素较多,需要对此加以关注,促进患者进行恢复正常控尿功能。

Objective To investigate the urinary control status of patients with prostate cancer after laparoscopic radical prostatectomy.Methods A retrospective analysis of the clinical data of 37 prostate cancer patients who underwent laparoscopic radical prostatectomy treated by the Department of Urology,Suqian Hospital of Xuzhou Medical University from January 2015 to September 2019,and surveyed and recorded the patients 6 months after surgery The recovery status of urinary control,and the influencing factors of the postoperative urinary control status of patients were counted.Results In this group of 37 patients,26 patients recovered urinary control 6 months after surgery,and the recovery rate was 70.27%.Patients with urinary control recovery are(59.86±3.47)years old and prostate volume(40.65±4.62)mL is less than those who have not recovered(67.21±4.16)years old and(47.63±5.57)mL,and preoperative IPSS(8.12±0.36)scores are lower than none Recovered(10.48±2.43)points(t=5.259,3.782,3.347,P<0.05);retention rates of bladder neck,prostatic urethra and vascular nerve bundles were 69.23%,76.92%and 80.77%higher than those who did not recover 18.18%,27.27%and 36.36%,respectively,the difference was statistically significant(χ^(2)=6.186,6.128,5.077,P<0.05);BMI(25.06±2.33)kg/m2 for those who recovered from urinary control and(25.12±3.38)kg/m2 for those who did not recover,the difference was not statistically significant(t=0.056,P>0.05);the tumor staging of those who recovered was 42.31%for stageⅠ-Ⅱ,57.69%for stageⅢ-Ⅳ,and 45.45% for stageⅠ-ⅡandⅢ-Ⅳfor those who did not recover.Stage 54.55%,recovery of tumors was poorly differentiated 42.31%,moderately differentiated 26.92%,well differentiated 30.77%,unrecovered tumors were poorly differentiated 36.36%,moderately differentiated 36.36%,and highly differentiated 27.27%,the difference was not statistically significant(χ^(2)=0.035,0.035,0.001,0.033,0.033,P>0.05).Logistic multi-factors showed that the influencing factors of the patient’s postoperative urinary control status include patient’s age,IPSS score,prostate volume,patient’s bladder neck,prostate urethra,and vascular and nerve bundle retention.Exp(B)is 1.266,2.848,1.125,12.335,14.264,15.416,95%CI were 1.043-1.236,1.071-1.455,1.238-124.758,1.562-5.123,1.165-158.731,1.536-96.852;BMI,tumor stage and The degree of differentiation has nothing to do with the patient's postoperative urinary control status,the difference was statistically significant(P>0.05).Conclusion There are many factors influencing the status of urinary control in patients with prostate cancer after laparoscopic radical prostatectomy,which needs to be paid attention to to promote the recovery of normal urinary control in patients.