腹腔镜保留前列腺尖部包膜根治性膀胱切除W形回肠新膀胱术尿控和勃起功能研究

Urinary continence and erectile function of laparoscopic radical cystectomy with prostatic apical capsule sparing and W-shaped ileal neobladder

目的探讨腹腔镜下保留前列腺尖部包膜根治性膀胱切除W形原位回肠新膀胱术的临床疗效。方法回顾性分析2019年1月至2021年12月行腹腔镜根治性膀胱切除W形回肠原位新膀胱术的43例男性膀胱癌患者的临床资料。分为保留前列腺尖部包膜组20例(观察组)和非保留前列腺尖部包膜组23例(对照组)。观察组在距前列腺尖部1.0 cm处切开前列腺包膜,剜除前列腺,保留部分前列腺包膜的腹腔镜膀胱根治切除。对照组采用常规腹腔镜膀胱根治切除。两组W形回肠新膀胱制作方法相同。术后3周拔除导尿管,每3个月定期复查,收集所有患者的临床资料和完整随访信息。结果所有患者均顺利完成手术。术后随访6~40个月无肿瘤复发。两组患者在术前人口学资料、膀胱肿瘤分期、手术时间、术中出血量、术中并发症、90 d内并发症发生率和术后6个月新膀胱残余尿量差异均无统计学意义(P>0.05)。术后6个月尿控率和勃起功能(IIEF-5评分)实验组优于对照组,日间尿控率分别为85.0%和52.2%(P<0.05),夜间尿控率分别为65.0%和34.8%(P<0.05),IIEF-5评分分别为[8(6,9)]分和[3(2,5)]分(P<0.05)。结论腹腔镜下保留前列腺尖部包膜根治性膀胱切除W形原位回肠新膀胱术有利于尿控和勃起功能保护,不会影响肿瘤控制效果,值得临床推广应用。

Objective To investigate the clinical effect of laparoscopic radical cystectomy with prostatic apical capsule sparing and W-shaped orthotopic ileal neobladder.Methods Clinical data of 43 patients underwent laparoscopic radical cystectomy with W-shaped ileum orthotopic neobladder from January 2019 to December 2021 were collected.20 cases were in prostatic apical capsule sparing group(observation group)and 23 cases were in the non prostatic apical capsule sparing group(control group).In the observation group,the prostatic apical capsule was cut at 1.0 cm from the tip of the prostate,the prostate was enucleated,and part of the prostatic apical capsule was reserved for laparoscopic radical cystectomy.The control group underwent conventional laparoscopic radical cystectomy.W-shaped ileal neobladder reconstructions were the same in both groups.The catheters were removed 3 weeks after operation,and the patients were reviewed regularly every 3 months.The clinical data and complete follow-up information of all patients were collected.Results All operation were finished successfully.Follow-up of all patients for 6-40 months revealed no tumor recurrence.There were no significant differences between two groups in preoperative demographic data,bladder tumor stage,operation time,intraoperative bleeding,intraoperative complications,90-day postoperative complication rate and neobladder residual urine volume 6 months after operation(P>0.05).Six months after operation,the urinary function and erectile function(IIEF-5 score)of the observation group were better than that of the control group.Daytime continence were 85.0% and 52.2% respectively(P<0.05),nighetime continence were 65.0% and 34.8% respectively(P<0.05),and the IIEF-5 score were[8(6,9)]and[3(2,5)]respectively(P<0.05).Conclusion Laparoscopic radical cystectomy with prostatic apical capsule sparing and W-shaped orthotopic ileal neobladder is conducive to urinary continence and erectile function which would not increase the risk of tumor recurrence.So it is worthy of clinical application.