腹腔镜前列腺癌根治术中采用膀胱颈口荷包缝合联合尿道周围组织重建的早期尿控效果

Early Urinary Continence Effects of Bladder Neck Purse-string Suture Combined With Urethral Reconstruction in Laparoscopic Radical Prostatectomy

目的探讨腹腔镜前列腺癌根治术中采用膀胱颈口荷包缝合联合尿道周围组织重建的早期尿控效果。方法2020年2月~2021年4月我们在20例腹腔镜前列腺癌根治术中采用膀胱颈口荷包缝合联合尿道周围组织重建。尿道后壁重建:将狄氏筋膜残端与尿道括约肌后壁中线结构缝合,再缝合至膀胱颈后壁筋膜;膀胱颈口荷包缝合及尿道吻合:将膀胱颈口肌层做连续荷包缝合,端端吻合膀胱颈及尿道;尿道前壁重建:将耻骨前列腺韧带与膀胱前壁连续缝合、悬吊尿道。结果20例手术均顺利完成,无中转开放或其他术式。手术时间(200.0±54.9)min,术中出血量(44.3±19.8)ml,术后住院时间(8.9±2.8)d,引流管留置时间(7.6±2.7)d,导尿管留置时间(12.9±2.6)d。术后病理:T2a期1例,T2b期4例,T2c期7例,T3a期5例,T3b期3例;术后标本病理Gleason评分:6分1例,7分9例,8分4例,9分5例,10分1例;切缘阳性率10%(2/20)。拔除导尿管后即刻和术后1、3、6个月尿控良好率分别为70%(14/20)、85%(17/20)、95%(19/20)、100%(20/20)。结论腹腔镜前列腺癌根治术中采用膀胱颈口荷包缝合联合尿道周围组织重建安全、可行,操作容易,患者术后早期尿控恢复满意。

Objective To investigate clinical value of bladder neck purse-string suture combined with urethral reconstruction in improving early urinary continence in laparoscopic radical prostatectomy.Methods Twenty patients with prostate cancer admitted to our hospital from February 2020 to April 2021 were enrolled in this study.These patients were treated with bladder neck purse-string suture combined with urethral reconstruction during laparoscopic radical prostatectomy.The reconstruction of the posterior wall of the urethra:the stump of the Diesel fascia was sutured to the midline structure of the posterior wall of the urethral sphincter,and then sutured to the fascia of the posterior wall of the bladder neck.The purse-string suture of the bladder neck and the urethra:the bladder neck muscle continuous purse-string suture was performed on the layers,and end-to-end anastomosis of the bladder neck and urethra was made.The reconstruction of the anterior wall of the urethra:the puboprostatic ligament and the anterior bladder wall were continuously sutured,and the urethra was suspended.Results The operations were successfully completed in all the 20 cases without conversion to open operation or other operation methods.The operative time was(200.0±54.9)min,the blood loss was(44.3±19.8)ml,the postoperative hospitalization time was(8.9±2.8)d,the drainage tube indwelling time was(7.6±2.7)d,and the catheter indwelling time was(12.9±2.6)d.Postoperative specimen pathology showed 1 case of T2a stage,4 cases of PT2b stage,7 cases of T2c stage,5 cases of T3a stage and 3 cases of T3b stage.Postoperative pathological Gleason score showed 6 points in 1 case,7 points in 9 cases,8 points in 4 cases,9 points in 5 cases,and 10 points in 1 case.The rate of positive margin was 10%(2/20).The rate of good urinary continence was 70%(14/20)immediately after removal of the catheter,and 85%(17/20),95%(19/20),and 100%(20/20)at 1 month,3 months and 6 months,respectively.Conclusion Bladder neck purse-string suture combined with urethral reconstruction in laparoscopic radical prostatectomy is safe,feasible,and easy to perform,and the patient’s early urinary continence is satisfactory.